Healthcare Provider Details

I. General information

NPI: 1881996049
Provider Name (Legal Business Name): TRACY MADONNA MORNING PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2010
Last Update Date: 11/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GEORGIA AVE NW
WASHINGTON DC
20307-0003
US

IV. Provider business mailing address

6900 GEORGIA AVE NW
WASHINGTON DC
20307-0003
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-4701
  • Fax: 202-782-0214
Mailing address:
  • Phone: 202-782-4701
  • Fax: 202-782-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number021496
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: