Provider Demographics
NPI:1730308446
Name:VICKERS, TOMMY EUGENE (RPH)
Entity Type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:EUGENE
Last Name:VICKERS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 ROAD 1200
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-7919
Mailing Address - Country:US
Mailing Address - Phone:662-844-2979
Mailing Address - Fax:
Practice Address - Street 1:410 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-2112
Practice Address - Country:US
Practice Address - Phone:662-837-7177
Practice Address - Fax:662-837-7719
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST09886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist