1396980025 NPI number — MRS. TRACEY JEANNE MCGAUGHEY PHARMD

Table of content: MRS. TRACEY JEANNE MCGAUGHEY PHARMD (NPI 1396980025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396980025 NPI number — MRS. TRACEY JEANNE MCGAUGHEY PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGAUGHEY
Provider First Name:
TRACEY
Provider Middle Name:
JEANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHULTZ
Provider Other First Name:
TRACEY
Provider Other Middle Name:
JEANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396980025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 41 BOX 2443
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09464-0025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
48TH MEDICAL GROUP
Provider Second Line Business Practice Location Address:
RAF LAKENHEATH UNIT 5115
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-226-8102
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , with the licence number:  PH233792 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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