Provider Demographics
NPI:1174655229
Name:TUCKER, KARAN TUCKER (RPH)
Entity Type:Individual
Prefix:
First Name:KARAN
Middle Name:TUCKER
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 ROBINHOOD RD
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-1821
Mailing Address - Country:US
Mailing Address - Phone:706-540-1031
Mailing Address - Fax:
Practice Address - Street 1:250 LANGLEY DR STE 1131
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-6932
Practice Address - Country:US
Practice Address - Phone:800-680-1804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA014060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGA014060OtherPHARMACIST LISENCE