Most Relevant Information
Provider Data
| NPI Number: | 1003439464 |
| Provider Name: | LE TRAC |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 029211 |
Most Important Dates
| Enumeration Date: | 05/20/2020 |
| Last Updated: | 05/20/2020 |
Provider Practice Location
4358 BURNS RD NW
LILBURN
GA
300473596
Practice Location Phone/Fax
| Phone: | 7705648023 |
| Fax: |
Provider Mailing Location
3824 SAFEHAVEN CT
LAWRENCEVILLE
GA
300444057
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |