Provider Demographics
NPI:1306124920
Name:THAI, TRACEY (RPH)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:THAI
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 1:302 NE NORTHGATE WAY
Mailing Address - Street 2:T-1284
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6047
Mailing Address - Country:US
Mailing Address - Phone:206-494-0898
Mailing Address - Fax:206-494-0898
Practice Address - Street 1:302 NE NORTHGATE WAY
Practice Address - Street 2:T-1284
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6047
Practice Address - Country:US
Practice Address - Phone:206-494-0898
Practice Address - Fax:206-494-0898
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-31
Last Update Date:2011-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA42607183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist