Provider Demographics
NPI:1780938175
Name:TUCKER, TRACEY B (RPH)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:B
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 BEACH CLUB TRL
Mailing Address - Street 2:DORAL 810
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-8142
Mailing Address - Country:US
Mailing Address - Phone:251-223-3165
Mailing Address - Fax:
Practice Address - Street 1:3820 GULF SHORES PKWY
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-2819
Practice Address - Country:US
Practice Address - Phone:251-967-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist