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General NPI Number Information
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NPI Number | 1215236591
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Entity Type | Individual
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Provider Name | ANGELA TRACY RPH
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Gender | Female
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Dates
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Enumeration Date | 03/25/2011
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Last Update Date | 12/05/2019
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Provider Practice Location Address
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Address Line | 1600 ORMSBY STATION CT
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City | LOUISVILLE
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State | KY
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Zip | 40223-4039
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Country | US
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Telephone | 502-558-8571
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Fax | 502-423-4176
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Provider Business Mailing Address
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Address Line | 720 WINDING OAKS TRL
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City | LOUISVILLE
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State | KY
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Zip | 40223-2300
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.293267
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 33510
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10176
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 010176
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License Number State | KY
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Taxonomy #5
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26023088A
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License Number State | IN
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