MEDICARE: DR. TRACEY HADDOCK

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	10818	SC

General Provider Information

NPI Number	:	1275883845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACEY HADDOCK

Provider Business Mailing Address
First Line	:	15 W ASHLAND ST
Second Line	:
City	:	ANDREWS
State	:	SC
Zip	:	29510-2543
Country	:	US
Telephone Number	:	843-264-3291
Fax Number	:	843-264-3291

Provider Business Practice Location Address
First Line	:	15 W ASHLAND ST
Second Line	:
City	:	ANDREWS
State	:	SC
Zip	:	29510-2543
Country	:	US
Telephone Number	:	843-264-3291
Fax Number	:	843-264-5425

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

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	05/30/2023

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Directions to “ DR. TRACEY HADDOCK ” Practice Location

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