Provider Demographics
NPI:1669413753
Name:JOHNSON, TRACY VERONICA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:VERONICA
Last Name:JOHNSON
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 1:8901 STONE CREEK PL
Mailing Address - Street 2:UNIT 201
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1043
Mailing Address - Country:US
Mailing Address - Phone:410-902-6701
Mailing Address - Fax:186-661-1422
Practice Address - Street 1:1700 REISTERSTOWN RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-1416
Practice Address - Country:US
Practice Address - Phone:410-653-7305
Practice Address - Fax:410-653-7303
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist