Provider Demographics
NPI:1952649543
Name:WEBER, TRACEY LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNN
Last Name:WEBER
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 1:487 CRAIN LN
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:KY
Mailing Address - Zip Code:41006-8963
Mailing Address - Country:US
Mailing Address - Phone:859-472-6830
Mailing Address - Fax:
Practice Address - Street 1:487 CRAIN LN
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:KY
Practice Address - Zip Code:41006-8963
Practice Address - Country:US
Practice Address - Phone:859-472-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009381183500000X
OH03216794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist