Provider Demographics
NPI:1093548703
Name:BRADY, TRACY LEE (PHARMD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:BRADY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1320
Mailing Address - Country:US
Mailing Address - Phone:402-305-9822
Mailing Address - Fax:
Practice Address - Street 1:14303 U ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2666
Practice Address - Country:US
Practice Address - Phone:402-895-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist