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NPI Code Detail

MEDICARE: TRACY PENROSE RPH

MEDICARE: TRACY PENROSE RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist03316158OH

General Provider Information

NPI Number : 1972593804
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY PENROSE RPH
Provider Business Mailing Address
First Line : 653 TAMARAC TRL
Second Line :
City : WADSWORTH
State : OH
Zip : 44281-2367
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 339 E MAPLE ST
Second Line : SUITE 100
City : NORTH CANTON
State : OH
Zip : 44720-2593
Country : US
Telephone Number : 800-858-7393
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2005
Last Update Date : 10/28/2010

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Directions to “ TRACY PENROSE RPH” Practice Location

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