Provider Demographics
NPI:1659026359
Name:PERRY, TRACY RYAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:RYAN
Last Name:PERRY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8219 PETERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-1489
Mailing Address - Country:US
Mailing Address - Phone:812-454-9769
Mailing Address - Fax:
Practice Address - Street 1:2500 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-2950
Practice Address - Country:US
Practice Address - Phone:812-647-9498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019599A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26019599AOtherINDIANA PHARMACY LICENSE