Healthcare Provider Details

I. General information

NPI: 1639714397
Provider Name (Legal Business Name): TUCKER PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2019
Last Update Date: 04/16/2023
Certification Date: 04/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 FAIRVIEW BLVD
FAIRVIEW TN
37062-9078
US

IV. Provider business mailing address

10394 TIDWELL RD
BON AQUA TN
37025-1567
US

V. Phone/Fax

Practice location:
  • Phone: 615-799-0691
  • Fax:
Mailing address:
  • Phone: 601-946-1826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JIMMY TUCKER
Title or Position: CEO
Credential:
Phone: 601-946-1826