Provider Demographics
NPI:1922392802
Name:TACKETT, ZACHARY TYLER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:TYLER
Last Name:TACKETT
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 1:813 COSGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-5264
Mailing Address - Country:US
Mailing Address - Phone:919-448-5804
Mailing Address - Fax:
Practice Address - Street 1:301 PHARMACY LANE
Practice Address - Street 2:UNC ESHELMAN SCHOOL OF PHARMACY CB # 7355
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7355
Practice Address - Country:US
Practice Address - Phone:919-448-5804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WVRP0008414183500000X, 1835P0018X, 1835P1200X
NC23996183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy