Provider Demographics
NPI:1184145930
Name:TERRY, TRACY (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CLAYTON CT
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-4789
Mailing Address - Country:US
Mailing Address - Phone:256-627-3017
Mailing Address - Fax:
Practice Address - Street 1:2701 CLOVERDALE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35633-1402
Practice Address - Country:US
Practice Address - Phone:256-712-6412
Practice Address - Fax:256-712-6413
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-02
Last Update Date:2017-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist