MEDICARE: GINA LOUISE TRACY RPH

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
1	183500000X	Pharmacist	13272	NV

General Provider Information

NPI Number	:	1336547835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA LOUISE TRACY RPH

Provider Business Mailing Address
First Line	:	6720 PLACID ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-3541
Country	:	US
Telephone Number	:	702-579-3292
Fax Number	:

Provider Business Practice Location Address
First Line	:	6720 PLACID ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-3541
Country	:	US
Telephone Number	:	702-579-3292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2014
Last Update Date	:	12/15/2014

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