TRACY J LARSEN (NPI# 1598386716) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598386716 |
| Entity Type | Individual |
| Full Name | TRACY J LARSEN |
| Credential | REGISTERED PHARMACIS |
| Practice Address |
13601 Kenton Ave Crestwood IL 60418-1938 |
| Practice Telephone | 7087588000 |
| Mailing Telephone | 7087528000 |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2020-04-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 051039230 | IL | Pharmacy Service Providers |
| N | 1835G0303X |
Pharmacist Specialization: Geriatric |
051039230 | IL | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407277189 | Tracy Brent Larsen | Nurse Anesthetist, Certified Registered | 2615 Chester Ave, Bakersfield, CA 93301-2014 | 2013-12-23 |
| 1366762080 | Tracy Larsen | Nurse Practitioner | 1401 Gateway Blvd, Rock Springs, WY 82901-6717 | 2010-06-03 |
| Street Address |
13601 KENTON AVE |
| City | CRESTWOOD |
| State | IL |
| Zip Code | 60418-1938 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740512094 | Medication Management Partners | Pharmacy | 13601 Kenton Ave, Crestwood, IL 60418-1938 | 2010-02-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083136477 | Ashley Sage | Behavioral Analyst | 13430 West Circle Drive, Unit 209, Crestwood, IL 60418 | 2017-07-07 |
| 1497847255 | Ebony Nicole Johnson | Family Medicine | 4742 Cal Sag Rd, Crestwood, IL 60418 | 2006-09-29 |
| 1215372404 | Malak Elsheikh | Internal Medicine | 13755 Cicero Ave, Crestwood, IL 60418 | 2013-05-02 |
| 1356591549 | Luciano Fochesatto Filho | Internal Medicine | 13755 Cicero Ave, Crestwood, IL 60418 | 2008-09-24 |
| 1538603329 | Megan Kateri Valesey | Behavioral Analyst | 12745 Central Ave, Crestwood, IL 60418-1130 | 2016-12-13 |
| 1720581143 | Manjhoni Edmondson | Counselor | 5305 Pleasant Ln, Crestwood, IL 60418-1159 | 2018-03-12 |
| 1194228429 | Illinois Supreme Health Organization | Community/Behavioral Health | 5305 Pleasant Ln, Crestwood, IL 60418-1159 | 2018-03-13 |
| 1962974782 | Chloe Haberkorn | Optometrist | 5247 131st St, Crestwood, IL 60418-1255 | 2018-12-18 |
| 1265060396 | Kaitlin Marie Featherstone | Student in an Organized Health Care Education/Training Program | 13217 E Playfield Dr, Crestwood, IL 60418-1303 | 2020-04-01 |
| 1982256632 | Laureate Crestwood Operations LLC | Skilled Nursing Facility | 13301 Central Ave, Crestwood, IL 60418-1370 | 2019-07-12 |
| Find all providers in zip 60418 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922609965 | Nolan Batch | Pharmacist | 6501 Veterans Memorial Pkwy, Crestwood, KY 40014-8694 | 2020-11-05 |
| 1811598246 | Zuwena Shavers | Pharmacist | 4700 135th St, Crestwood, IL 60418-1405 | 2020-11-03 |
| 1205436862 | Linda Louise Scarnavack | Pharmacist | 4700 135th St, Crestwood, IL 60418-1405 | 2020-10-31 |
| 1861092611 | Brittany Vittitow | Pharmacist | 6501 Veterans Memorial Pkwy, Crestwood, KY 40014-8694 | 2020-10-30 |
| 1013517812 | Richard William Menard | Pharmacist | 6501 Veterans Memorial Pkwy, Crestwood, KY 40014-8694 | 2020-10-29 |
| 1841802196 | Patricia Marie Arteaga | Pharmacist | 13501 Cicero Ave, Crestwood, IL 60418-1934 | 2020-08-18 |
| 1407499460 | Rebecca Souliotis | Pharmacist | 4700 135th St, Crestwood, IL 60418-1405 | 2019-10-22 |
| 1720351752 | Mark Mccarthy | Pharmacist | 13501 Cicero Ave, Crestwood, IL 60445-1934 | 2012-02-22 |
| 1235409137 | Jennifer Kathleen Donovan | Pharmacist | 5071 Cal Sag Rd, (t-0868), Crestwood, IL 60445-1458 | 2012-01-09 |
| 1215213509 | Shavon Clark-howard | Pharmacist | 13501 Cicero Ave, Crestwood, IL 60445-1934 | 2011-10-31 |
| Find all providers in CRESTWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.