Organization
MARK A TACKETT
Active
Organization
MARK A TACKETT
Active
Other names
TACKETT PHARMACY AND NUTRITION CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
TARA PENNY PHARM D (PIC)
(817) 341-7046
Entity
Organization
Contact information
Practice address
138 COLLEGE PARK DR STE 130, WEATHERFORD, TX 76086-6372
(817) 341-7046
(817) 341-7380
Mailing address
138 COLLEGE PARK DR STE 130, WEATHERFORD, TX 76086-6372
(817) 341-7046
(817) 341-7380
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
27110
TX
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148282
—
TX
01
—
2125348
PK
—
Enumeration date
07/03/2010
Last updated
06/09/2016
Update your record
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