Provider Demographics
NPI:1992855803
Name:WIX, TRACY CHESTEEN (RPH)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:CHESTEEN
Last Name:WIX
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 1:8260 HWY 72W
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:AL
Mailing Address - Zip Code:35616
Mailing Address - Country:US
Mailing Address - Phone:256-359-6242
Mailing Address - Fax:256-359-4652
Practice Address - Street 1:8260 HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:AL
Practice Address - Zip Code:35616-4402
Practice Address - Country:US
Practice Address - Phone:256-359-6242
Practice Address - Fax:256-359-4652
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-31
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-07-31
Provider Licenses
StateLicense IDTaxonomies
AL10848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist