MEDICARE: MRS. NICOLE TUCKER MCCONNELL 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	21940	TN
2	183500000X	Pharmacist	14428	AL

General Provider Information

NPI Number	:	1316902760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE TUCKER MCCONNELL PHARMD

Provider Business Mailing Address
First Line	:	310 OAKFAIR DR
Second Line	:
City	:	ROGERSVILLE
State	:	AL
Zip	:	35652-5762
Country	:	US
Telephone Number	:	256-247-3018
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 CHURCH ST
Second Line	:
City	:	LORETTO
State	:	TN
Zip	:	38469-2143
Country	:	US
Telephone Number	:	931-853-5910
Fax Number	:	931-853-5930

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/08/2007

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