Provider Demographics
NPI:1538430392
Name:TUCKETT, TANYA NICOLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:NICOLE
Last Name:TUCKETT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 S STAPLES ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2346
Mailing Address - Country:US
Mailing Address - Phone:361-814-5806
Mailing Address - Fax:361-814-4189
Practice Address - Street 1:3750 S STAPLES ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2346
Practice Address - Country:US
Practice Address - Phone:361-814-5806
Practice Address - Fax:361-814-4189
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist