Provider Demographics
NPI:1518006204
Name:FARRILL, TRACY LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LYNN
Last Name:FARRILL
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 1:43423 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-7127
Mailing Address - Country:US
Mailing Address - Phone:405-598-0749
Mailing Address - Fax:
Practice Address - Street 1:HWYS JCT 270 & 56
Practice Address - Street 2:WEWOKA INDIAN HEALTH CENTER
Practice Address - City:WEWOKA
Practice Address - State:OK
Practice Address - Zip Code:74884-1475
Practice Address - Country:US
Practice Address - Phone:405-257-7361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist