Provider Demographics
NPI:1407216153
Name:JENNINGS, TRACY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2604
Mailing Address - Country:US
Mailing Address - Phone:859-331-1272
Mailing Address - Fax:
Practice Address - Street 1:53 DONNERMEYER DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:KY
Practice Address - Zip Code:41073-1352
Practice Address - Country:US
Practice Address - Phone:859-431-5413
Practice Address - Fax:859-491-0302
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist