MEDICARE: TRACY HUMPHREYS 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	PH00014867	WA

General Provider Information

NPI Number	:	1669876264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY HUMPHREYS RPH

Provider Business Mailing Address
First Line	:	8915 MARKET PL
Second Line	:	SUITE 100
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-4916
Country	:	US
Telephone Number	:	425-377-7110
Fax Number	:	425-377-7128

Provider Business Practice Location Address
First Line	:	8915 MARKET PL
Second Line	:	SUITE 100
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-4916
Country	:	US
Telephone Number	:	425-377-7110
Fax Number	:	425-377-7128

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

Provider Enumeration Date	:	10/10/2014
Last Update Date	:	10/10/2014

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Directions to “ TRACY HUMPHREYS RPH” Practice Location

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