Provider Demographics
NPI:1255521910
Name:TENNANT, TRACY J (RP)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:J
Last Name:TENNANT
Suffix:
Gender:F
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 W NORFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4438
Mailing Address - Country:US
Mailing Address - Phone:402-644-7523
Mailing Address - Fax:402-644-7267
Practice Address - Street 1:2700 W NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4438
Practice Address - Country:US
Practice Address - Phone:402-644-7523
Practice Address - Fax:402-644-7267
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist