Provider Demographics
NPI:1124029186
Name:TICKERHOOF, TESSA CAMILLE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:TESSA
Middle Name:CAMILLE
Last Name:TICKERHOOF
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5414
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-5414
Mailing Address - Country:US
Mailing Address - Phone:706-714-1660
Mailing Address - Fax:706-543-0484
Practice Address - Street 1:191 ALPS RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-4093
Practice Address - Country:US
Practice Address - Phone:706-543-3553
Practice Address - Fax:706-543-0484
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist