Provider Demographics
NPI:1619209947
Name:KOVACS, TRACY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:KOVACS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 ORISKANY BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-1318
Mailing Address - Country:US
Mailing Address - Phone:315-292-1374
Mailing Address - Fax:
Practice Address - Street 1:40 ORISKANY BLVD
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492-1318
Practice Address - Country:US
Practice Address - Phone:315-292-1374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist