Provider Demographics
NPI:1154606895
Name:BUCKNER, TAMMY DENISE (RPH)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:DENISE
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 JACKSBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-3003
Mailing Address - Country:US
Mailing Address - Phone:423-566-0786
Mailing Address - Fax:423-566-0864
Practice Address - Street 1:2109 JACKSBORO PIKE
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3003
Practice Address - Country:US
Practice Address - Phone:423-494-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000022078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist