Provider Demographics
NPI:1033487251
Name:CAIN, TRACY NICHOLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:NICHOLE
Last Name:CAIN
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 1:245 S. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716
Mailing Address - Country:US
Mailing Address - Phone:865-387-0019
Mailing Address - Fax:
Practice Address - Street 1:245 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-3603
Practice Address - Country:US
Practice Address - Phone:865-387-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000012174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist