Individual
MRS. TRACIE LYNN HALE-SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1123 WASHINGTON ST, VICKSBURG, MS 39183-2959
(601) 636-2756
(601) 638-0071
Mailing address
196 FAIRWAYS DR, VICKSBURG, MS 39183-8304
(601) 636-5822
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E07658
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E07658
STATE LICENSE
MS
Enumeration date
08/18/2006
Last updated
07/08/2007
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