Provider Demographics
NPI:1336422757
Name:STREEPY, TRACEY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:
Last Name:STREEPY
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 1:423 DRAKE DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-4241
Mailing Address - Country:US
Mailing Address - Phone:334-793-2414
Mailing Address - Fax:
Practice Address - Street 1:4650 W MAIN ST STE 700
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1152
Practice Address - Country:US
Practice Address - Phone:334-792-6824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist