Provider Demographics
NPI:1902904899
Name:SANCHEZ, TRACEY DAVILA (RPH)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:DAVILA
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:TRACEY
Other - Middle Name:NOEMI
Other - Last Name:DAVILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:4910 VALLEY MILL DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2442
Mailing Address - Country:US
Mailing Address - Phone:361-334-4248
Mailing Address - Fax:
Practice Address - Street 1:6434 SARATOGA BLVD STE A
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3425
Practice Address - Country:US
Practice Address - Phone:361-991-2191
Practice Address - Fax:361-806-5616
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist