Provider Demographics
NPI:1023385416
Name:TRACY, ERICKA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:ERICKA
Middle Name:
Last Name:TRACY
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 1:13117 CLOVERLEAF LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-1126
Mailing Address - Country:US
Mailing Address - Phone:405-833-3349
Mailing Address - Fax:
Practice Address - Street 1:116 N GREEN AVE
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-4012
Practice Address - Country:US
Practice Address - Phone:405-527-0251
Practice Address - Fax:405-527-0094
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist