Healthcare Provider Details

I. General information

NPI: 1003250028
Provider Name (Legal Business Name): TRACY RHODES PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2013
Last Update Date: 04/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4013 PHELAN RD
PHELAN CA
92371-8912
US

IV. Provider business mailing address

27468 CLOVERLEAF DR #1135
HELENDALE CA
92342-7747
US

V. Phone/Fax

Practice location:
  • Phone: 760-868-3413
  • Fax:
Mailing address:
  • Phone: 814-952-0208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number68522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: