Healthcare Provider Details

I. General information

NPI: 1528036795
Provider Name (Legal Business Name): NOREEN ANNE TRACY
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5277 LINCOLN HWY
GAP PA
17527-9427
US

IV. Provider business mailing address

577 BUTTERNUT DR
PARKESBURG PA
19365-1774
US

V. Phone/Fax

Practice location:
  • Phone: 717-442-9523
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP032648T
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: