Healthcare Provider Details

I. General information

NPI: 1851533210
Provider Name (Legal Business Name): TRACI MICHELLE WHITE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 S TELSHOR BLVD STE 201
LAS CRUCES NM
88011-4907
US

IV. Provider business mailing address

2530 S TELSHOR BLVD STE 201
LAS CRUCES NM
88011-4907
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-1749
  • Fax: 575-556-1754
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number6947
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: