MEDICARE: TRACI S POWERS 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	183500000X	Pharmacist	36263	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992173512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI S POWERS PHARMD

Provider Business Mailing Address
First Line	:	538 S EADDY FORD RD
Second Line	:
City	:	JOHNSONVILLE
State	:	SC
Zip	:	29555-5201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3320 4TH AVE STE F
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29527-6057
Country	:	US
Telephone Number	:	843-248-6550
Fax Number	:

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

Provider Enumeration Date	:	09/14/2015
Last Update Date	:	12/28/2017

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Directions to “ TRACI S POWERS PHARMD” Practice Location

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