Healthcare Provider Details

I. General information

NPI: 1710526397
Provider Name (Legal Business Name): TUCKER GILBERT ENSLEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 DEERFIELD RD
BOONE NC
28607-5476
US

IV. Provider business mailing address

230 ADAMS LN APT D
BOONE NC
28607-7793
US

V. Phone/Fax

Practice location:
  • Phone: 828-264-3055
  • Fax:
Mailing address:
  • Phone: 828-606-8347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28997
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: