Provider Demographics
NPI:1235124132
Name:TUCKER, TIMOTHY L (PHARM D)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:TUCKER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 TARA LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344-1705
Mailing Address - Country:US
Mailing Address - Phone:731-986-2167
Mailing Address - Fax:731-986-2171
Practice Address - Street 1:553 TARA LN
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344-1705
Practice Address - Country:US
Practice Address - Phone:731-986-2167
Practice Address - Fax:731-986-2171
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3912911Medicaid
TN3912911Medicare PIN