MEDICARE: MARILYN TUCKER D.PH.

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	7825	TN

General Provider Information

NPI Number	:	1477891034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN TUCKER D.PH.

Provider Business Mailing Address
First Line	:	2000 MALLORY LN
Second Line	:	#130-341
City	:	FRANKLIN
State	:	TN
Zip	:	37067-8209
Country	:	US
Telephone Number	:	615-300-3037
Fax Number	:	615-292-0434

Provider Business Practice Location Address
First Line	:	2000 MALLORY LN
Second Line	:	#130-341
City	:	FRANKLIN
State	:	TN
Zip	:	37067-8209
Country	:	US
Telephone Number	:	615-300-3037
Fax Number	:	615-292-0434

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

Provider Enumeration Date	:	01/16/2013
Last Update Date	:	01/16/2013

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