Active NPI
Le Trac
- Pharmacist
- Lilburn, GA
National Provider Identifier
1003439464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 029211
- Practice address
- 4358 Burns Rd NW
Lilburn, GA 30047-3596 - Phone
- (770) 564-8023
- NPI assigned
- May 20, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 029211 | GA | Primary |
Addresses
Primary practice location
4358 Burns Rd NW
Lilburn, GA 30047-3596
Mailing address
3824 Safehaven CT
Lawrenceville, GA 30044-4057
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 029211 | GA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Georgia CVS Pharmacy L.L.C | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Pooler, GA
- NPI 1578009130
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589932800000",
"number": "1003439464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3824 SAFEHAVEN CT",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300444057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4358 BURNS RD NW",
"city": "LILBURN",
"state": "GA",
"postal_code": "300473596",
"telephone_number": "770-564-8023"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRAC",
"first_name": "LE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-20",
"last_updated": "2020-05-20",
"certification_date": "2020-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "029211",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lilburn, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.