Individual
CELIA RENEE TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
105 E ELKHORN ST, ELKHORN CITY, KY 41522-8557
(606) 754-0221
(606) 754-0225
Mailing address
105 E ELKHORN ST, ELKHORN CITY, KY 41522-8557
(606) 754-0221
(606) 754-0225
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
015482
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015482
STATE LICENSE
KY
Enumeration date
07/04/2012
Last updated
10/21/2020
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