Provider Demographics
NPI:1588951297
Name:GRUNEWALD, TRACY E (RPH)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:E
Last Name:GRUNEWALD
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:CVS PHARMACY 16548 (INSIDE TARGET)
Mailing Address - Street 2:1205 SOUTH WASHINGTON ST
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760
Mailing Address - Country:US
Mailing Address - Phone:508-695-9335
Mailing Address - Fax:508-316-8248
Practice Address - Street 1:1205 S WASHINGTON ST
Practice Address - Street 2:TARGET PHARMACY T-1190
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-6251
Practice Address - Country:US
Practice Address - Phone:508-695-9335
Practice Address - Fax:508-695-9335
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist