Provider Demographics
NPI:1003145020
Name:TRACY, JOHN MICHAEL SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:TRACY
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:38 LOCKE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5422
Mailing Address - Country:US
Mailing Address - Phone:603-223-0380
Mailing Address - Fax:603-223-0347
Practice Address - Street 1:38 LOCKE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5422
Practice Address - Country:US
Practice Address - Phone:603-223-0380
Practice Address - Fax:603-223-0347
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NHR1789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist