Individual
TRACY TA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
2635 RICE ST, ROSEVILLE, MN 55113-3717
(651) 483-3976
(651) 483-0064
Mailing address
2635 RICE ST, ROSEVILLE, MN 55113-3717
(651) 483-3976
(651) 483-0064
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
117006
MN
Other
Enumeration date
11/21/2011
Last updated
11/21/2011
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