Healthcare Provider Details

I. General information

NPI: 1659394088
Provider Name (Legal Business Name): TRACIE MARIE BALVANZ PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LOCUST ST # 119
RENO NV
89502-2597
US

IV. Provider business mailing address

4776 SCENIC HILL CIR
RENO NV
89523-9403
US

V. Phone/Fax

Practice location:
  • Phone: 775-328-1840
  • Fax:
Mailing address:
  • Phone: 775-746-4845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number12125
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number16842
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: