Healthcare Provider Details

I. General information

NPI: 1164609780
Provider Name (Legal Business Name): TRACY LYNN TULOWIECKI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9021 CLEMENT CIR
TERRELL NC
28682-9718
US

IV. Provider business mailing address

9021 CLEMENT CIR
TERRELL NC
28682-9718
US

V. Phone/Fax

Practice location:
  • Phone: 704-488-5413
  • Fax:
Mailing address:
  • Phone: 704-488-5413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17458
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number44433
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: