Provider Demographics
NPI:1598084345
Name:TREST, TRACY LEE (PHARM D)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:TREST
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LEE
Other - Last Name:HEIMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:100 N W CARLOS G. PARKER BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-7060
Mailing Address - Country:US
Mailing Address - Phone:512-352-2024
Mailing Address - Fax:512-352-2052
Practice Address - Street 1:100 N W CARLOS G. PARKER BLVD
Practice Address - Street 2:STE 101
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-7060
Practice Address - Country:US
Practice Address - Phone:512-352-2024
Practice Address - Fax:512-352-2052
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist