Provider Demographics
NPI:1497355861
Name:TUCKER, TYLER D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:D
Last Name:TUCKER
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 1:203 FIREWHEEL ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-7509
Mailing Address - Country:US
Mailing Address - Phone:806-898-6329
Mailing Address - Fax:
Practice Address - Street 1:1501 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4408
Practice Address - Country:US
Practice Address - Phone:806-274-7243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist