Provider Demographics
NPI:1649792821
Name:COPELAND, JACY TUCKER (PHARM D)
Entity type:Individual
Prefix:
First Name:JACY
Middle Name:TUCKER
Last Name:COPELAND
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 1:420 W BELL AVE STE P
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-3404
Mailing Address - Country:US
Mailing Address - Phone:423-648-4310
Mailing Address - Fax:423-648-4312
Practice Address - Street 1:420 W BELL AVE STE P
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3404
Practice Address - Country:US
Practice Address - Phone:423-648-4310
Practice Address - Fax:423-648-4312
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist