Provider Demographics
NPI:1225173339
Name:CUSHMAN, TRACY T (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:T
Last Name:CUSHMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:A
Other - Last Name:TRAMMELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:AL
Mailing Address - Zip Code:35117
Mailing Address - Country:US
Mailing Address - Phone:205-608-0288
Mailing Address - Fax:
Practice Address - Street 1:584 MORRIS MAJESTIC RD
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:AL
Practice Address - Zip Code:35116
Practice Address - Country:US
Practice Address - Phone:205-647-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist