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General NPI Number Information
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NPI Number | 1134926520
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Entity Type | Individual
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Provider Name | TRACI LYNN PETERS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 24988 SE STARK ST STE 320
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City | GRESHAM
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State | OR
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Zip | 97030-8325
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Country | US
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Telephone | 503-674-1229
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Fax | 503-674-1169
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Provider Business Mailing Address
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Address Line | 11531 SE ROSS RD
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-6440
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Country | US
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Telephone | 503-679-4505
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Fax | 503-674-1169
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | IND-908853
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RPH-0009623
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License Number State | OR
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