Individual
MALLORY KECK TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
102 E BROADWAY, NEWPORT, TN 37821-2323
(423) 623-0364
Mailing address
102 E BROADWAY, NEWPORT, TN 37821-2323
(423) 623-0364
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
43318
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
43318
TENNESSEE BOARD OF PHARMACY
TN
Enumeration date
08/24/2020
Last updated
08/24/2020
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