Basic Information
| Provider Information | |||||||||
| NPI: | 1306390687 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAESSIG | ||||||||
| FirstName: | TRACEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARM D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4910 S YOSEMITE ST | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801111383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037732390 | ||||||||
| FaxNumber: | 3037412563 | ||||||||
| Practice Location | |||||||||
| Address1: | 4910 S YOSEMITE ST | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801111383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037732390 | ||||||||
| FaxNumber: | 3037412563 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2016 | ||||||||
| LastUpdateDate: | 08/04/2016 | ||||||||
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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 | 18408 | CO | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.