MEDICARE: DR. TRACIE SANNICANDRO OSGOOD PHARMD

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	1835G0303X	Geriatric Pharmacist	009947	SC
2	1835G0303X	Geriatric Pharmacist	23431	MA
3	1835G0303X	Geriatric Pharmacist	08503	CT
4	1835G0303X	Geriatric Pharmacist	0202204687	VA
5	1835G0303X	Geriatric Pharmacist	RP-043684-R	PA
6	1835P1200X	Pharmacotherapy Pharmacist	009947	SC
7	1835P1200X	Pharmacotherapy Pharmacist	8503	CT
8	1835P1200X	Pharmacotherapy Pharmacist	0202204687	VA
9	1835P1200X	Pharmacotherapy Pharmacist	RP-043684-R	PA
10	1835P1200X	Pharmacotherapy Pharmacist	23431	MA

General Provider Information

NPI Number	:	1912091802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACIE SANNICANDRO OSGOOD PHARMD

Provider Business Mailing Address
First Line	:	25 COURTENAY DR
Second Line	:	SECOND FLOOR ASHLEY RIVER TOWER PHARMACY
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8911
Country	:	US
Telephone Number	:	843-876-5588
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 COURTENAY DR
Second Line	:	SECOND FLOOR ASHLEY RIVER TOWER PHARMACY
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8911
Country	:	US
Telephone Number	:	843-876-5588
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	09/06/2011

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Directions to “ DR. TRACIE SANNICANDRO OSGOOD PHARMD” Practice Location

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