Provider Demographics
NPI:1033701297
Name:LAURENT, TRACIE LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:LEE
Last Name:LAURENT
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 1:455 HUNTER CT
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4360
Mailing Address - Country:US
Mailing Address - Phone:303-667-5748
Mailing Address - Fax:
Practice Address - Street 1:1919 QUENTIN ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7125
Practice Address - Country:US
Practice Address - Phone:720-857-6422
Practice Address - Fax:720-857-6509
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist