Provider Demographics
NPI:1902013436
Name:DONNELLY, TRACY LEIGH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LEIGH
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 W LITTLE NECK RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4715
Mailing Address - Country:US
Mailing Address - Phone:757-428-5650
Mailing Address - Fax:757-463-3357
Practice Address - Street 1:2110 GREAT NECK SQ
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2202
Practice Address - Country:US
Practice Address - Phone:757-481-5458
Practice Address - Fax:757-481-7417
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist