Healthcare Provider Details

I. General information

NPI: 1699206060
Provider Name (Legal Business Name): JAMIE LYNN TUCKER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 LILLIAN LANE
DEMOPOLIS AL
36732
US

IV. Provider business mailing address

1107 LILLIAN LANE
DEMOPOLIS AL
36732
US

V. Phone/Fax

Practice location:
  • Phone: 334-507-8266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16748
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number34319
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number010790
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: