Provider Demographics
NPI:1720198989
Name:TACKETT, JENNIFER LEIGH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEIGH
Last Name:TACKETT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12838 SR 333
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:AR
Mailing Address - Zip Code:72837-9123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8880 MARKET ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:AR
Practice Address - Zip Code:72837-9111
Practice Address - Country:US
Practice Address - Phone:479-331-2133
Practice Address - Fax:479-331-4003
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist