Provider Demographics
NPI:1760663967
Name:KILLIAN, TRACY JEANNE (RPH)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:JEANNE
Last Name:KILLIAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 PARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-2525
Mailing Address - Country:US
Mailing Address - Phone:607-547-8568
Mailing Address - Fax:
Practice Address - Street 1:119 PARSHALL RD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-2525
Practice Address - Country:US
Practice Address - Phone:607-547-8568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist