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General NPI Number Information
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NPI Number | 1164034203
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Entity Type | Individual
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Provider Name | TRACEY RICA HUMBERT PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/19/2020
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 999 SEBASTIAN BLVD
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City | SEBASTIAN
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State | FL
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Zip | 32958-4861
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Country | US
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Telephone | 772-388-1096
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Fax |
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Provider Business Mailing Address
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Address Line | 288 BRANDY CREEK CIR SE
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City | PALM BAY
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State | FL
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Zip | 32909-2332
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Country | US
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Telephone |
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Fax |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS57147
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License Number State | FL
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