Provider Demographics
NPI:1982006490
Name:TRACY, GARY (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:TRACY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 BRIARWOOD PL
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-8304
Mailing Address - Country:US
Mailing Address - Phone:509-670-8140
Mailing Address - Fax:
Practice Address - Street 1:1399 NAT WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-2629
Practice Address - Country:US
Practice Address - Phone:509-754-8847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00020067183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist