Provider Demographics
NPI:1376871582
Name:BAYER, TRACI (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:
Last Name:BAYER
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 1:4847 SLIDE RD
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-3405
Mailing Address - Country:US
Mailing Address - Phone:806-792-8267
Mailing Address - Fax:806-792-8323
Practice Address - Street 1:4847 SLIDE RD
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3405
Practice Address - Country:US
Practice Address - Phone:806-792-8267
Practice Address - Fax:806-792-8323
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-28
Last Update Date:2009-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47089183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist