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General NPI Number Information
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NPI Number | 1922442185
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Entity Type | Individual
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Provider Name | TRACY NICOLE ANDERSON PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 04/18/2013
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 270 S SERVICE RD STE 25
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City | MELVILLE
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State | NY
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Zip | 11747-2399
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Country | US
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Telephone | 631-237-8594
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Fax |
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Provider Business Mailing Address
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Address Line | 129 ADAMS ST
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City | DEER PARK
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State | NY
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Zip | 11729-3025
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Country | US
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Telephone | 347-419-7767
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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 | 65200
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 072254
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License Number State | NY
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