Provider Demographics
NPI:1780860650
Name:WARD, TRACY SOMERS (RPH)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:SOMERS
Last Name:WARD
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 1:3083 CAMBRIDGE HILL DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1626
Mailing Address - Country:US
Mailing Address - Phone:678-546-7483
Mailing Address - Fax:
Practice Address - Street 1:2175 PARKLAKE DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2809
Practice Address - Country:US
Practice Address - Phone:404-790-8951
Practice Address - Fax:770-496-7562
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023516183500000X
NC11832183500000X
VA0202010970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist