Provider Demographics
NPI:1386056570
Name:OSBORNE, TRACY (PHARMD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1715 ELIJAH BLUE DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6816
Mailing Address - Country:US
Mailing Address - Phone:317-885-3010
Mailing Address - Fax:317-885-3065
Practice Address - Street 1:150 S MARLIN DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1451
Practice Address - Country:US
Practice Address - Phone:317-885-3010
Practice Address - Fax:317-885-3065
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022258A1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy