Provider Demographics
NPI:1609903475
Name:MONKEVICH, TRACY STEVEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:STEVEN
Last Name:MONKEVICH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35000 23 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-4438
Mailing Address - Country:US
Mailing Address - Phone:586-725-6903
Mailing Address - Fax:586-725-5443
Practice Address - Street 1:35000 23 MILE RD
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-4438
Practice Address - Country:US
Practice Address - Phone:586-725-6903
Practice Address - Fax:586-725-5443
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030208183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist