Healthcare Provider Details

I. General information

NPI: 1912091802
Provider Name (Legal Business Name): TRACIE SANNICANDRO OSGOOD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COURTENAY DR SECOND FLOOR ASHLEY RIVER TOWER PHARMACY
CHARLESTON SC
29425-8911
US

IV. Provider business mailing address

25 COURTENAY DR SECOND FLOOR ASHLEY RIVER TOWER PHARMACY
CHARLESTON SC
29425-8911
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-5588
  • Fax:
Mailing address:
  • Phone: 843-876-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number009947
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number23431
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number08503
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number0202204687
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRP-043684-R
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number009947
License Number StateSC
# 7
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number8503
License Number StateCT
# 8
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number0202204687
License Number StateVA
# 9
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP-043684-R
License Number StatePA
# 10
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number23431
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: