Provider Demographics
NPI:1366054447
Name:PARSONS, TRACIE LEIGH (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:LEIGH
Last Name:PARSONS
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 1:102 RUSSELL PKWY
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-6165
Mailing Address - Country:US
Mailing Address - Phone:478-542-2064
Mailing Address - Fax:478-542-2129
Practice Address - Street 1:102 RUSSELL PKWY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6165
Practice Address - Country:US
Practice Address - Phone:478-542-2064
Practice Address - Fax:478-542-2129
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist