Provider Demographics
NPI:1548507502
Name:LIPSCOMB, TRACEY EUGENE (PHARM D)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:EUGENE
Last Name:LIPSCOMB
Suffix:
Gender:M
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 1:3446 WINDER HWY
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-3007
Mailing Address - Country:US
Mailing Address - Phone:770-538-4276
Mailing Address - Fax:770-503-9677
Practice Address - Street 1:3446 WINDER HWY
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-3007
Practice Address - Country:US
Practice Address - Phone:770-538-4276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist