Provider Demographics
NPI:1407137680
Name:HANKS, TRACI DAWN (DPH)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:DAWN
Last Name:HANKS
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 W MEMORIAL RD STE 106
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8305
Mailing Address - Country:US
Mailing Address - Phone:405-752-3590
Mailing Address - Fax:405-752-3885
Practice Address - Street 1:4200 W MEMORIAL RD STE 106
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8305
Practice Address - Country:US
Practice Address - Phone:405-752-3590
Practice Address - Fax:405-752-3885
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist