Provider Demographics
NPI:1134414261
Name:TUCKER, MELVA ALICIA (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:MELVA
Middle Name:ALICIA
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 ANDREWS RUN
Mailing Address - Street 2:T-1511
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-1232
Mailing Address - Country:US
Mailing Address - Phone:615-826-7971
Mailing Address - Fax:615-826-7971
Practice Address - Street 1:1004 ANDREWS RUN
Practice Address - Street 2:T-1511
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-1232
Practice Address - Country:US
Practice Address - Phone:615-826-7971
Practice Address - Fax:615-826-7971
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist