Provider Demographics
NPI:1932403839
Name:RUMAN, TRACEY SOWELL (RPH)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:SOWELL
Last Name:RUMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:TRACEY
Other - Middle Name:SOWELL
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:10406 RINDER FARM CT
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-3879
Mailing Address - Country:US
Mailing Address - Phone:864-650-4366
Mailing Address - Fax:
Practice Address - Street 1:8731 POTEET JOURDANTON FWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-3879
Practice Address - Country:US
Practice Address - Phone:210-927-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH3110183500000X
SC007734183500000X
TX44212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN