Basic Information
| Provider Information | |||||||||
| NPI: | 1003145020 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRACY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38 LOCKE RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033015422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032230380 | ||||||||
| FaxNumber: | 6032230347 | ||||||||
| Practice Location | |||||||||
| Address1: | 38 LOCKE RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033015422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032230380 | ||||||||
| FaxNumber: | 6032230347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2009 | ||||||||
| LastUpdateDate: | 12/22/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | R1789 | NH | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.