Provider Demographics
NPI:1174611149
Name:KEMP, DOUGLAS TUCKER (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:TUCKER
Last Name:KEMP
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 DAANDRA DR
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-1584
Mailing Address - Country:US
Mailing Address - Phone:706-202-2638
Mailing Address - Fax:
Practice Address - Street 1:1939 HOMER RD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-1254
Practice Address - Country:US
Practice Address - Phone:706-335-0099
Practice Address - Fax:706-335-0078
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH011051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist