Provider Demographics
NPI:1417587718
Name:ATTEBURY, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:ATTEBURY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 CLARKSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-6033
Mailing Address - Country:US
Mailing Address - Phone:903-785-1922
Mailing Address - Fax:903-784-5456
Practice Address - Street 1:1310 CLARKSVILLE ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-6033
Practice Address - Country:US
Practice Address - Phone:903-785-1922
Practice Address - Fax:903-784-5456
Is Sole Proprietor?:No
Enumeration Date:2020-01-25
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX287291835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist