Provider Demographics
NPI:1326118407
Name:TUCKER & DAHL LLC
Entity Type:Organization
Organization Name:TUCKER & DAHL LLC
Other - Org Name:DAHL'S PHARMACY OF CARSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-423-5491
Mailing Address - Street 1:PO BOX 5160
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89407-5160
Mailing Address - Country:US
Mailing Address - Phone:775-885-8881
Mailing Address - Fax:775-885-2690
Practice Address - Street 1:1007 N CURRY ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3975
Practice Address - Country:US
Practice Address - Phone:775-885-8881
Practice Address - Fax:775-885-2690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336L0003X
NVPH00611333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157662OtherPK