Individual
REGGIE TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3120 BERRY FARM RD, CARLISLE, SC 29031-9242
(803) 477-2564
Mailing address
3120 BERRY FARM RD, CARLISLE, SC 29031-9242
(803) 477-2564
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
007865475
SC
Other
Enumeration date
10/11/2024
Last updated
10/11/2024
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