Provider Demographics
NPI:1851996656
Name:DUCKETT, PEARLIE LEANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:PEARLIE
Middle Name:LEANNE
Last Name:DUCKETT
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 1:11054 RICH VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-0568
Mailing Address - Country:US
Mailing Address - Phone:276-791-9481
Mailing Address - Fax:
Practice Address - Street 1:3030 W STATE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1719
Practice Address - Country:US
Practice Address - Phone:423-764-7105
Practice Address - Fax:423-764-0610
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist