Provider Demographics
NPI:1366707010
Name:SAEPHANH, TRACY C
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:C
Last Name:SAEPHANH
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 1:14901 4TH AVE SW STE 100
Mailing Address - Street 2:BARTELL DRUGS - BURIEN
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166
Mailing Address - Country:US
Mailing Address - Phone:206-242-1202
Mailing Address - Fax:
Practice Address - Street 1:14901 4TH AVE SW STE 100
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166
Practice Address - Country:US
Practice Address - Phone:206-242-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60084808183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician