Provider Demographics
NPI:1942516141
Name:BOATRIGHT, TRACY H (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:H
Last Name:BOATRIGHT
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 1:733 W. SPRINGFIELD
Mailing Address - Street 2:P.O. BOX 176
Mailing Address - City:GERALD
Mailing Address - State:MO
Mailing Address - Zip Code:63037
Mailing Address - Country:US
Mailing Address - Phone:573-764-5980
Mailing Address - Fax:573-764-5982
Practice Address - Street 1:733 W. SPRINGFIELD
Practice Address - Street 2:
Practice Address - City:GERALD
Practice Address - State:MO
Practice Address - Zip Code:63037
Practice Address - Country:US
Practice Address - Phone:573-764-5980
Practice Address - Fax:573-764-5982
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist