Healthcare Provider Details

I. General information

NPI: 1962328658
Provider Name (Legal Business Name): TRACY TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WILMOT RD
DEERFIELD IL
60015-5145
US

IV. Provider business mailing address

108 WILMOT RD
DEERFIELD IL
60015-5145
US

V. Phone/Fax

Practice location:
  • Phone: 800-825-5467
  • Fax: 800-332-9581
Mailing address:
  • Phone: 800-825-5467
  • Fax: 800-332-9581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS024297
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: