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General NPI Number Information
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NPI Number | 1972593804
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Entity Type | Individual
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Provider Name | TRACY PENROSE RPH
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Gender | Female
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Dates
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Enumeration Date | 10/22/2005
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 339 E MAPLE ST SUITE 100
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City | NORTH CANTON
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State | OH
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Zip | 44720-2593
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Country | US
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Telephone | 800-858-7393
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Fax |
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Provider Business Mailing Address
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Address Line | 653 TAMARAC TRL
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City | WADSWORTH
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State | OH
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Zip | 44281-2367
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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 | 03316158
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License Number State | OH
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