Individual
TRACIE KENYON
Active
Individual
TRACIE KENYON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
5302025428
MI
1835P1200X
Pharmacotherapy Pharmacist
PS39138
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1835P1200X
PHARMACIST-PHARMACOTHERAPY
MI
Enumeration date
05/01/2014
Last updated
05/01/2014
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