Provider Demographics
NPI:1508923855
Name:MCKENNA, TRACEY M (PHARM D)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:M
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:M
Other - Last Name:HESSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1575 ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:IA
Mailing Address - Zip Code:50438
Mailing Address - Country:US
Mailing Address - Phone:641-923-5273
Mailing Address - Fax:
Practice Address - Street 1:2006 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-4603
Practice Address - Country:US
Practice Address - Phone:641-423-5178
Practice Address - Fax:641-424-0975
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist