MEDICARE: TRACY KATHRYN WANG

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	129658-8913	UT

General Provider Information

NPI Number	:	1962045633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY KATHRYN WANG

Provider Business Mailing Address
First Line	:	845 E 4500 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3049
Country	:	US
Telephone Number	:	801-261-8787
Fax Number	:	801-263-8523

Provider Business Practice Location Address
First Line	:	845 E 4500 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3049
Country	:	US
Telephone Number	:	801-261-8787
Fax Number	:	801-263-8523

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

Provider Enumeration Date	:	10/24/2019
Last Update Date	:	10/24/2019

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Directions to “ TRACY KATHRYN WANG ” Practice Location

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