Provider Demographics
NPI:1467755272
Name:DAVIS, TASHA TUCKER (PHARMD)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:TUCKER
Last Name:DAVIS
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 1:2424 ORLANDO CENTRAL PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-5600
Mailing Address - Country:US
Mailing Address - Phone:877-747-7259
Mailing Address - Fax:407-852-0962
Practice Address - Street 1:2424 ORLANDO CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5600
Practice Address - Country:US
Practice Address - Phone:877-747-7259
Practice Address - Fax:407-852-0962
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD159671835P0018X
FLPS32806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist