Individual
DR. TRACY SHANNON ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.PH.
Contact information
Practice address
800 FIR ST, PERRY, OK 73077-4239
(580) 336-4474
(580) 336-0108
Mailing address
800 FIR ST, PERRY, OK 73077-4239
(580) 336-4474
(580) 336-0108
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12550
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12550
LICENSE NUMBER
OK
Enumeration date
08/17/2006
Last updated
07/08/2007
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