Provider Demographics
NPI:1568547073
Name:JEPSON, TRACY RAE (RPH)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:RAE
Last Name:JEPSON
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 1:1802 N. ANKENY BLVD.
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4768
Mailing Address - Country:US
Mailing Address - Phone:515-289-0911
Mailing Address - Fax:515-963-1907
Practice Address - Street 1:1802 N. ANKENY BLVD.
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4768
Practice Address - Country:US
Practice Address - Phone:515-289-0911
Practice Address - Fax:515-963-1907
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist