Provider Demographics
NPI:1497166946
Name:SHUGAR, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:SHUGAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ARROW SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-7002
Mailing Address - Country:US
Mailing Address - Phone:513-282-7020
Mailing Address - Fax:
Practice Address - Street 1:100 ARROW SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-7002
Practice Address - Country:US
Practice Address - Phone:513-282-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-17
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120957183500000X
IN26016716A183500000X
KY011020183500000X
CA43184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist