Healthcare Provider Details

I. General information

NPI: 1407216153
Provider Name (Legal Business Name): TRACY JENNINGS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 DONNERMEYER DR
BELLEVUE KY
41073-1352
US

IV. Provider business mailing address

10 BARRINGTON RD
FT WRIGHT KY
41011-2604
US

V. Phone/Fax

Practice location:
  • Phone: 859-431-5413
  • Fax: 859-491-0302
Mailing address:
  • Phone: 859-331-1272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number011001
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: