Provider Demographics
NPI:1164709184
Name:MONTOUCET, TRACIE LYNN (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:LYNN
Last Name:MONTOUCET
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LANDSDOWNE WAY
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-6251
Mailing Address - Country:US
Mailing Address - Phone:337-278-2181
Mailing Address - Fax:
Practice Address - Street 1:812 VETERANS DR
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-3701
Practice Address - Country:US
Practice Address - Phone:337-896-2217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist