Individual
DR. TRACY K. PETTINGER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PHARM.D.
Contact information
Practice address
465 MEMORIAL DR, IDAHO STATE UNIVERSITY, POCATELLO, ID 83201-4008
(208) 282-5012
Mailing address
IDAHO STATE UNIVERSITY, CAMPUS BOX 8357, POCATELLO, ID 83209-0001
(208) 282-5012
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
P5743
ID
Other
Enumeration date
09/23/2005
Last updated
07/08/2007
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