Healthcare Provider Details

I. General information

NPI: 1659023497
Provider Name (Legal Business Name): TRACY L ESCHELBACHER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/24/2022
Certification Date: 01/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 W BOCKMAN WAY
SPARTA TN
38583-1832
US

IV. Provider business mailing address

145 PHILLIPS BEND CT
COOKEVILLE TN
38506-5785
US

V. Phone/Fax

Practice location:
  • Phone: 931-836-3230
  • Fax: 931-836-3241
Mailing address:
  • Phone: 931-252-2917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10172
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: