Organization
K-TUCK L L C
Active
Other names
central pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH D TUCKER RPH (PHARMACIST)
(843) 759-2800
Entity
Organization
Contact information
Practice address
303 N MAIN ST, LAKE VIEW, SC 29563
(843) 759-2800
(843) 759-9974
Mailing address
PO BOX 1248, LAKE VIEW, SC 29563-1248
(843) 759-2800
(843) 759-9974
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
50005766
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DE1265
—
SC
Enumeration date
06/01/2007
Last updated
06/17/2008
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