Provider Demographics
NPI:1780878983
Name:CARTER, TRACEE ANN (PHARMD)
Entity type:Individual
Prefix:
First Name:TRACEE
Middle Name:ANN
Last Name:CARTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TRACEE
Other - Middle Name:
Other - Last Name:MATHIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:104 S BRYANT AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6327
Mailing Address - Country:US
Mailing Address - Phone:405-348-1677
Mailing Address - Fax:405-359-9040
Practice Address - Street 1:104 S BRYANT AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6327
Practice Address - Country:US
Practice Address - Phone:405-348-1677
Practice Address - Fax:405-359-9040
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist