Individual
DR. JORDAN TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
911 BYPASS RD BLDG E, PIKEVILLE, KY 41501-1689
(606) 218-3576
Mailing address
640 MARE CRK, STANVILLE, KY 41659-9000
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
020231
KY
Other
Enumeration date
10/11/2020
Last updated
10/11/2020
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