Provider Demographics
NPI:1720966831
Name:TRACY, ANGELICA MARIE (RPH)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIE
Last Name:TRACY
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 1:1260 HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2839
Mailing Address - Country:US
Mailing Address - Phone:269-983-0315
Mailing Address - Fax:
Practice Address - Street 1:1260 HILLTOP RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2839
Practice Address - Country:US
Practice Address - Phone:269-983-0315
Practice Address - Fax:269-983-2389
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302417849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist