Provider Demographics
NPI:1477123081
Name:VANDERBURG, JAMES TUCKER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TUCKER
Last Name:VANDERBURG
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 1:1331 W MOREHEAD ST APT 220
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5371
Mailing Address - Country:US
Mailing Address - Phone:901-651-7816
Mailing Address - Fax:
Practice Address - Street 1:2975 UNION RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-6023
Practice Address - Country:US
Practice Address - Phone:704-867-6957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist