MEDICARE: TRACY NG

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	74197	CA

General Provider Information

NPI Number	:	1659746204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY NG

Provider Business Mailing Address
First Line	:	1071 EL CAMINO REAL
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94063-1689
Country	:	US
Telephone Number	:	650-306-1902
Fax Number	:	650-302-1905

Provider Business Practice Location Address
First Line	:	1071 EL CAMINO REAL
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94063-1689
Country	:	US
Telephone Number	:	650-306-1902
Fax Number	:	650-306-1095

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

Provider Enumeration Date	:	12/08/2015
Last Update Date	:	12/09/2015

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Directions to “ TRACY NG ” Practice Location

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