Provider Demographics
NPI:1265643290
Name:OVERBAY, TRACY L (RPH)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:L
Last Name:OVERBAY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 TALLSMAN DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5400
Mailing Address - Country:US
Mailing Address - Phone:505-890-5858
Mailing Address - Fax:
Practice Address - Street 1:10236 COORS BYP NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4088
Practice Address - Country:US
Practice Address - Phone:505-898-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist