MEDICARE: TRACY ANNE MARRA RPH

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	183500000X	Pharmacist	RP0039002L	PA

General Provider Information

NPI Number	:	1043814320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY ANNE MARRA RPH

Provider Business Mailing Address
First Line	:	1565 W HARRISBURG PIKE
Second Line	:
City	:	MIDDLETOWN
State	:	PA
Zip	:	17057-4852
Country	:	US
Telephone Number	:	717-944-9681
Fax Number	:	717-944-1747

Provider Business Practice Location Address
First Line	:	1565 W HARRISBURG PIKE
Second Line	:
City	:	MIDDLETOWN
State	:	PA
Zip	:	17057-4852
Country	:	US
Telephone Number	:	717-944-9681
Fax Number	:	717-944-1747

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

Provider Enumeration Date	:	11/26/2020
Last Update Date	:	11/26/2020

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