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General NPI Number Information
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NPI Number | 1184630287
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Entity Type | Individual
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Provider Name | JODIE MARIE LASSETER TUCKER PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 200 W OGLETHORPE HWY
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City | HINESVILLE
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State | GA
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Zip | 31313-3615
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Country | US
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Telephone | 912-876-8125
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Fax | 912-876-4387
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Provider Business Mailing Address
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Address Line | 516 GREENWICH ST
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City | RICHMOND HILL
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State | GA
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Zip | 31324
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Country | US
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Telephone | 912-756-8489
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Fax | 912-876-4387
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH020867
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License Number State | GA
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