Provider Demographics
NPI:1275870321
Name:TACHER, JACK (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:TACHER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10130 NORTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33412-1101
Mailing Address - Country:US
Mailing Address - Phone:561-799-6808
Mailing Address - Fax:561-799-6814
Practice Address - Street 1:10130 NORTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33412-1101
Practice Address - Country:US
Practice Address - Phone:561-799-6808
Practice Address - Fax:561-799-6814
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0035682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist