1598084345 NPI number — TRACY LEE TREST PHARM D

Table of content: TRACY LEE TREST PHARM D (NPI 1598084345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598084345 NPI number — TRACY LEE TREST PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TREST
Provider First Name:
TRACY
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARM D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEIMER
Provider Other First Name:
TRACY
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARM D
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1598084345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N W CARLOS G. PARKER BLVD
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
TAYLOR
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76574-7060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-352-2024
Provider Business Mailing Address Fax Number:
512-352-2052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N W CARLOS G. PARKER BLVD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
TAYLOR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76574-7060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-352-2024
Provider Business Practice Location Address Fax Number:
512-352-2052
Provider Enumeration Date:
05/19/2010

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: 183500000X , with the licence number:  37290 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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