Healthcare Provider Details

I. General information

NPI: 1861512238
Provider Name (Legal Business Name): TRACI YVONNE DANSBERRY PHARM.D., RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7909 HWY N
DARDENNE PRAIRIE MO
63368
US

IV. Provider business mailing address

4534 CAMBROOK DR
SAINT CHARLES MO
63304-8714
US

V. Phone/Fax

Practice location:
  • Phone: 636-561-8450
  • Fax: 636-561-8455
Mailing address:
  • Phone: 636-477-1989
  • Fax: 636-447-4942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number045213
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: