Provider Demographics
NPI:1891063178
Name:TUCKER, JESSICA ELLEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ELLEN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:ELLEN
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1628 SIMPSON HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-4294
Mailing Address - Country:US
Mailing Address - Phone:601-849-4959
Mailing Address - Fax:601-849-6645
Practice Address - Street 1:1628 SIMPSON HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-4294
Practice Address - Country:US
Practice Address - Phone:601-849-4959
Practice Address - Fax:601-849-6645
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST10175183500000X
LA17227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist