Provider Demographics
NPI:1225343478
Name:BECKER, TRACY BAILEY (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:BAILEY
Last Name:BECKER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:KAY
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:818 WESTBANK EXPY
Mailing Address - Street 2:
Mailing Address - City:WESTWEGO
Mailing Address - State:LA
Mailing Address - Zip Code:70094-4607
Mailing Address - Country:US
Mailing Address - Phone:504-348-1026
Mailing Address - Fax:
Practice Address - Street 1:818 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:WESTWEGO
Practice Address - State:LA
Practice Address - Zip Code:70094-4607
Practice Address - Country:US
Practice Address - Phone:504-348-1026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist