Tracy DO
Individual provider Active NPI Pharmacist · Del City, OK
NPI 1801147368 · NPPES record last updated Sep 24, 2012
Key facts
- NPI
- 1801147368
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 15296 (OK)
- Practice address
- 4300 SE 29TH St
Del City, OK 73115-3312 - Phone
- (405) 677-5519
- Fax
- (405) 677-7357
- NPI assigned
- Sep 24, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15296 | OK | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 15296 | OK | Yes |
Addresses
Primary practice location
4300 SE 29TH St
Del City, OK 73115-3312
Mailing address
12216 Long Lake Blvd
Oklahoma City, OK 73170-4744
Other providers in Del City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 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.