MEDICARE: MR. JAMES F SHUCK DPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5126	TN

General Provider Information

NPI Number	:	1003814708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES F SHUCK DPH

Provider Business Mailing Address
First Line	:	PO BOX 850
Second Line	:
City	:	ROGERSVILLE
State	:	TN
Zip	:	37857-0850
Country	:	US
Telephone Number	:	423-921-6944
Fax Number	:	423-272-8706

Provider Business Practice Location Address
First Line	:	4966 HIGHWAY 11W
Second Line	:
City	:	ROGERSVILLE
State	:	TN
Zip	:	37857-6028
Country	:	US
Telephone Number	:	423-921-6944
Fax Number	:	423-272-8706

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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