Healthcare Provider Details

I. General information

NPI: 1184917007
Provider Name (Legal Business Name): DAVID HERBERT TUCKER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 VETERANS MEMORIAL HWY SUITE 1
LITHIA SPRINGS GA
30122-1800
US

IV. Provider business mailing address

3750 VETERANS MEMORIAL HWY SUITE 1
LITHIA SPRINGS GA
30122-1800
US

V. Phone/Fax

Practice location:
  • Phone: 770-948-8825
  • Fax: 770-948-8848
Mailing address:
  • Phone: 770-948-8825
  • Fax: 770-948-8848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH019281
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: