| Doctor Name: | BRENT TACKITT |
| NPI Number: | 1063833127 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHARMD |
| License Number: | 2008029231 |
| Business Practice Address: | 1768 Winding Glen Dr Saint Charles, MO - 633035099 |
| Business Phone Number: | 6182928476 |
| Business Fax Number: | |
| Mailing Address: | 1768 Winding Glen Dr, SAINT CHARLES |
| State: | MO |
| Postal Code: | 633035099 |
| Phone Number: | 6182928476 |
| Fax Number: | |
| NPI Enumeration Date: | 12/16/2013 |
| NPI Last Update Date: | 12/16/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835P0018X |
| License Number: | 2008029231 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Taxonomy Definition: | Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |