Provider Demographics
NPI:1851937130
Name:NEWMAN, TRACY ANN
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 LUCE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1277
Mailing Address - Country:US
Mailing Address - Phone:317-213-0325
Mailing Address - Fax:317-884-3327
Practice Address - Street 1:8745 S EMERSON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-9400
Practice Address - Country:US
Practice Address - Phone:317-884-3325
Practice Address - Fax:317-884-3327
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018660A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist