Provider Demographics
NPI:1831688266
Name:DACUS, TONYA
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:DACUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-2622
Mailing Address - Country:US
Mailing Address - Phone:901-870-0540
Mailing Address - Fax:
Practice Address - Street 1:6727 RALEIGH LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7017
Practice Address - Country:US
Practice Address - Phone:901-498-5327
Practice Address - Fax:901-498-5338
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist