Provider Demographics
NPI:1609097377
Name:AUSTIN, TRACEY L (RPH)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:AUSTIN
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 1:2811 LONDON GROVEPORT RD
Mailing Address - Street 2:MEIJER PHARMACY
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9035
Mailing Address - Country:US
Mailing Address - Phone:614-801-4310
Mailing Address - Fax:614-801-4365
Practice Address - Street 1:2811 LONDON GROVEPORT RD
Practice Address - Street 2:MEIJER PHARMACY
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-9035
Practice Address - Country:US
Practice Address - Phone:614-801-4310
Practice Address - Fax:614-801-4365
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-18701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist