Healthcare Provider Details

I. General information

NPI: 1700072451
Provider Name (Legal Business Name): NANCY MOE TRACY PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7191 10TH ST N
OAKDALE MN
55128-5943
US

IV. Provider business mailing address

7191 10TH ST N
OAKDALE MN
55128-5943
US

V. Phone/Fax

Practice location:
  • Phone: 651-731-7961
  • Fax: 651-731-7964
Mailing address:
  • Phone: 651-731-7961
  • Fax: 651-731-7964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number118869
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: