1225173339 NPI number — MRS. TRACY T CUSHMAN RPH

Table of content: MRS. TRACY T CUSHMAN RPH (NPI 1225173339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225173339 NPI number — MRS. TRACY T CUSHMAN RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUSHMAN
Provider First Name:
TRACY
Provider Middle Name:
T
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRAMMELL
Provider Other First Name:
TRACY
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225173339
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 222
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT OLIVE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-608-0288
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
584 MORRIS MAJESTIC RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRIS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-647-0515
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2007

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:  11788 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com