Provider Demographics
NPI:1912227554
Name:GANTT, TRACY C (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:C
Last Name:GANTT
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 1:521 SLATE HILL DR
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-5705
Mailing Address - Country:US
Mailing Address - Phone:614-323-1920
Mailing Address - Fax:
Practice Address - Street 1:521 SLATE HILL DR
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-5705
Practice Address - Country:US
Practice Address - Phone:614-323-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-06
Last Update Date:2010-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRPH.03328966-3183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist