MEDICARE: DR. JEREMY TUCKER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	25362	NC

General Provider Information

NPI Number	:	1245698893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY TUCKER PHARMD

Provider Business Mailing Address
First Line	:	612 PARHAM RD
Second Line	:
City	:	HENDERSON
State	:	NC
Zip	:	27536-2625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1419 E ANDREWS AVE
Second Line	:
City	:	HENDERSON
State	:	NC
Zip	:	27536-5202
Country	:	US
Telephone Number	:	252-433-0553
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2016
Last Update Date	:	02/10/2016

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