Tracy Beth Head, PHARMD, CGP
Individual provider Active NPI Pharmacist · Deforest, WI
NPI 1043429707 · NPPES record last updated Nov 14, 2012
Key facts
- NPI
- 1043429707
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 14709-040 (WI)
- Practice address
- 643 S. Main Street
Deforest, WI 53532 - Phone
- (608) 846-2750
- Fax
- (608) 846-2751
- NPI assigned
- May 21, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14709-040 | WI | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 14709-040 | WI | Yes |
Addresses
Primary practice location
643 S. Main Street
Deforest, WI 53532
Mailing address
643 S. Main Street
Deforest, WI 53532
Phone (608) 846-2750
Other providers in Deforest, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.