MEDICARE: TRACY LEANN FLANAGAN

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	051287907	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051287907	OTHER	IL	051287907
2	051287907	OTHER	IL	STATE OF ILLINOIS

General Provider Information

NPI Number	:	1952905101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY LEANN FLANAGAN

Provider Business Mailing Address
First Line	:	936 S MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-3014
Country	:	US
Telephone Number	:	217-243-1728
Fax Number	:	217-243-8380

Provider Business Practice Location Address
First Line	:	936 S MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-3014
Country	:	US
Telephone Number	:	217-243-1728
Fax Number	:	217-143-8380

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

Provider Enumeration Date	:	11/29/2020
Last Update Date	:	11/29/2020

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Directions to “ TRACY LEANN FLANAGAN ” Practice Location

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