Provider Demographics
NPI:1427334135
Name:LYKINS, TRACIE CRAWFORD (PHARMD)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:CRAWFORD
Last Name:LYKINS
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 1:300 N. MORLEY
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270
Mailing Address - Country:US
Mailing Address - Phone:660-263-0909
Mailing Address - Fax:660-263-2124
Practice Address - Street 1:300 N. MORLEY
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270
Practice Address - Country:US
Practice Address - Phone:660-263-0909
Practice Address - Fax:660-263-2124
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010029512183500000X
OH03127806183500000X
KY013813183500000X
VA0202206208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist