Healthcare Provider Details

I. General information

NPI: 1255442133
Provider Name (Legal Business Name): TRACY J MCCOMBS PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 WORNALL RD B LEVEL MAIN PHARMACY
KANSAS CITY MO
64111-3220
US

IV. Provider business mailing address

2831 N 99TH ST
KANSAS CITY KS
66109-4313
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-2000
  • Fax:
Mailing address:
  • Phone: 913-334-6837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number2008000710
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number2008000710
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2008000710
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number2008000710
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number2008000710
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: