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NPI Code Detail

MEDICARE: TRACY LYNN HAVER R.PH.

MEDICARE:   TRACY LYNN HAVER  R.PH.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist5302029036MI

General Provider Information

NPI Number : 1265661292
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY LYNN HAVER R.PH.
Provider Business Mailing Address
First Line : 511 S GARFIELD AVE
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-3423
Country : US
Telephone Number : 231-941-5332
Fax Number :
Provider Business Practice Location Address
First Line : 511 S GARFIELD AVE
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-3423
Country : US
Telephone Number : 231-941-5332
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2009
Last Update Date : 07/12/2009

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Directions to “ TRACY LYNN HAVER R.PH.” Practice Location

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