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NPI Code Detail

MEDICARE: TRACIE DEARDORFF PHARMD, RPH

MEDICARE: TRACIE DEARDORFF PHARMD, 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
1183500000XPharmacist016187KY
2183500000XPharmacist03132228OH

General Provider Information

NPI Number : 1164778916
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACIE DEARDORFF PHARMD, RPH
Provider Business Mailing Address
First Line : 1982 EIGHT MILE RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45255-2609
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1982 EIGHT MILE RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45255-2609
Country : US
Telephone Number : 513-474-4723
Fax Number : 513-474-4769
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2012
Last Update Date : 08/01/2023

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1265057491 — DINA ABOUELSEOUD
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