Provider Demographics
NPI:1003401613
Name:KITCHENS, TRACY LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:KITCHENS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 ELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2533
Mailing Address - Country:US
Mailing Address - Phone:815-673-7450
Mailing Address - Fax:
Practice Address - Street 1:348 ELLINGTON DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2533
Practice Address - Country:US
Practice Address - Phone:815-673-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPH.42289183500000X
TN46872183500000X
GARPH031715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist