Healthcare Provider Details

I. General information

NPI: 1043217540
Provider Name (Legal Business Name): TRACEY HOWARD TRUESDALE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 LEROY GEORGE DR
CLYDE NC
28721-7430
US

IV. Provider business mailing address

17 GOOD DAY CT
CANDLER NC
28715-7700
US

V. Phone/Fax

Practice location:
  • Phone: 828-452-8020
  • Fax:
Mailing address:
  • Phone: 828-713-8851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number16894
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: