Provider Demographics
NPI:1124628805
Name:BORKENHAGEN, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BORKENHAGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 HALLECK DR
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-3832
Mailing Address - Country:US
Mailing Address - Phone:610-533-6477
Mailing Address - Fax:
Practice Address - Street 1:2601 MACARTHUR RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-3818
Practice Address - Country:US
Practice Address - Phone:610-266-9375
Practice Address - Fax:610-266-9423
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044360L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist