Provider Demographics
NPI:1003091869
Name:TOWNE, TRACY ANN (RPH)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:ANN
Last Name:TOWNE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-2402
Mailing Address - Country:US
Mailing Address - Phone:518-725-8659
Mailing Address - Fax:518-725-9757
Practice Address - Street 1:169 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-2402
Practice Address - Country:US
Practice Address - Phone:518-725-8659
Practice Address - Fax:518-725-9757
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-29
Last Update Date:2007-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044900-1333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy