Provider Demographics
NPI:1114503083
Name:HART, TRACY DEAN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:DEAN
Last Name:HART
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 ELLIOTT PL
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-4048
Mailing Address - Country:US
Mailing Address - Phone:423-291-9645
Mailing Address - Fax:
Practice Address - Street 1:6390 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-2301
Practice Address - Country:US
Practice Address - Phone:228-818-3391
Practice Address - Fax:228-818-4491
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-13261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist