Provider Demographics
NPI:1316214547
Name:LINDLEY, TRACI (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:LINDLEY
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 1:301 W BENNETT AVE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-5179
Mailing Address - Country:US
Mailing Address - Phone:712-325-0619
Mailing Address - Fax:
Practice Address - Street 1:301 W BENNETT AVE
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-5179
Practice Address - Country:US
Practice Address - Phone:712-325-0619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist