Provider Demographics
NPI:1033484852
Name:LAY, TRACY (RPH)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:LAY
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 1:20000 HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1011
Mailing Address - Country:US
Mailing Address - Phone:734-464-8545
Mailing Address - Fax:734-464-5970
Practice Address - Street 1:20000 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1011
Practice Address - Country:US
Practice Address - Phone:734-464-8545
Practice Address - Fax:734-464-5970
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist