Provider Demographics
NPI:1427238922
Name:DRYER, TRACY DEE (RPH)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:DEE
Last Name:DRYER
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 1:605 SW US HWY 40, SUITE #440
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014
Mailing Address - Country:US
Mailing Address - Phone:816-944-0688
Mailing Address - Fax:888-380-0839
Practice Address - Street 1:2246 SW WALL STREET
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015
Practice Address - Country:US
Practice Address - Phone:816-944-0688
Practice Address - Fax:888-380-0839
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0422081835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1427238922Medicaid
MO606057602Medicaid