Healthcare Provider Details

I. General information

NPI: 1801881776
Provider Name (Legal Business Name): TONY L TUCKER D. PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 OAK DR
HUNTINGDON TN
38344-2210
US

IV. Provider business mailing address

132 OAK DR
HUNTINGDON TN
38344-2210
US

V. Phone/Fax

Practice location:
  • Phone: 731-986-4173
  • Fax: 731-986-2171
Mailing address:
  • Phone: 731-986-4173
  • Fax: 731-986-2171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4763
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: