MEDICARE: DR. TRACEY HOWARD TRUESDALE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	16894	NC

General Provider Information

NPI Number	:	1043217540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACEY HOWARD TRUESDALE PHARMD

Provider Business Mailing Address
First Line	:	17 GOOD DAY CT
Second Line	:
City	:	CANDLER
State	:	NC
Zip	:	28715-7700
Country	:	US
Telephone Number	:	828-713-8851
Fax Number	:

Provider Business Practice Location Address
First Line	:	262 LEROY GEORGE DR
Second Line	:
City	:	CLYDE
State	:	NC
Zip	:	28721-7430
Country	:	US
Telephone Number	:	828-452-8020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/08/2007

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