Provider Demographics
NPI:1326147349
Name:LEMOINE, TRACY J (RPH)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:J
Last Name:LEMOINE
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 1:20040 LEA BROOK PL
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3637
Mailing Address - Country:US
Mailing Address - Phone:251-990-9004
Mailing Address - Fax:251-621-3970
Practice Address - Street 1:187 BALDWIN SQ
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2046
Practice Address - Country:US
Practice Address - Phone:251-990-5779
Practice Address - Fax:251-990-5717
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11764OtherPHARMACIST LICENSE NUMBER