Provider Demographics
NPI:1104917186
Name:MCCARTHY, TRACEY LYNNE (RPH)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNNE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 MCLENDON HILLS DR
Mailing Address - Street 2:
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376-8368
Mailing Address - Country:US
Mailing Address - Phone:910-673-5577
Mailing Address - Fax:
Practice Address - Street 1:120 MACDOUGALL DR.
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376
Practice Address - Country:US
Practice Address - Phone:910-673-7467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036766-1183500000X
NC19424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist