Provider Demographics
NPI:1811732290
Name:TUCKER, TREVOR DALTON (PHARMD)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:DALTON
Last Name:TUCKER
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 1:3012 BEELER LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-6353
Mailing Address - Country:US
Mailing Address - Phone:276-608-8234
Mailing Address - Fax:
Practice Address - Street 1:760 CABARRUS AVE W
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-6851
Practice Address - Country:US
Practice Address - Phone:704-788-6337
Practice Address - Fax:704-788-6338
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC331081835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy