Healthcare Provider Details

I. General information

NPI: 1174611149
Provider Name (Legal Business Name): DOUGLAS TUCKER KEMP PHARM.D., RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 HOMER RD
COMMERCE GA
30529-1254
US

IV. Provider business mailing address

1141 DAANDRA DR
WATKINSVILLE GA
30677-1584
US

V. Phone/Fax

Practice location:
  • Phone: 706-335-0099
  • Fax: 706-335-0078
Mailing address:
  • Phone: 706-202-2638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH011051
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: