Provider Demographics
NPI:1861097099
Name:JETER, THOMAS RUCKER JR (BS PHARM, RPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RUCKER
Last Name:JETER
Suffix:JR
Gender:M
Credentials:BS PHARM, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 ROBERT E LEE LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-6828
Mailing Address - Country:US
Mailing Address - Phone:770-367-7766
Mailing Address - Fax:
Practice Address - Street 1:1415 ROBERT E LEE LN
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-6828
Practice Address - Country:US
Practice Address - Phone:770-367-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000428501835G0303X
SC379501835G0303X
GA0143051835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric