Provider Demographics
NPI:1881280402
Name:TACKER, NOAH S (PHARM D)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:S
Last Name:TACKER
Suffix:
Gender:M
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 1:500 N MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:AR
Mailing Address - Zip Code:72422-1616
Mailing Address - Country:US
Mailing Address - Phone:870-857-1006
Mailing Address - Fax:870-857-3391
Practice Address - Street 1:500 N MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:AR
Practice Address - Zip Code:72422-1616
Practice Address - Country:US
Practice Address - Phone:870-857-1006
Practice Address - Fax:870-857-3391
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist