Provider Demographics
NPI:1588254569
Name:EILERS, TRACI (PHARMD)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:EILERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67661-2716
Mailing Address - Country:US
Mailing Address - Phone:605-760-1675
Mailing Address - Fax:
Practice Address - Street 1:300 STATE ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:KS
Practice Address - Zip Code:67661-1930
Practice Address - Country:US
Practice Address - Phone:785-543-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-102993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist