Provider Demographics
NPI:1568777597
Name:BRIAN, TRACY RENEE (RPH)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:RENEE
Last Name:BRIAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:RENEE
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:7117 TRISSINO DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739
Mailing Address - Country:US
Mailing Address - Phone:512-796-9362
Mailing Address - Fax:
Practice Address - Street 1:6205 FM 2770
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640
Practice Address - Country:US
Practice Address - Phone:512-268-2040
Practice Address - Fax:512-268-2539
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-14
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist