Healthcare Provider Details

I. General information

NPI: 1184994626
Provider Name (Legal Business Name): TRACI BETH VREHAS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 02/13/2021
Certification Date: 02/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8845 KENNEDY AVE
HIGHLAND IN
46322-1908
US

IV. Provider business mailing address

8845 KENNEDY AVE
HIGHLAND IN
46322-1908
US

V. Phone/Fax

Practice location:
  • Phone: 219-972-1700
  • Fax:
Mailing address:
  • Phone: 219-972-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051289396
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2001030596
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS40602
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26026005A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: