Provider Demographics
NPI:1215259478
Name:WILLIAMS, TRACEY (RPH)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-3630
Mailing Address - Country:US
Mailing Address - Phone:212-246-8169
Mailing Address - Fax:212-265-7364
Practice Address - Street 1:687 9TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-3630
Practice Address - Country:US
Practice Address - Phone:212-246-8169
Practice Address - Fax:212-265-7364
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist