Provider Demographics
NPI:1992090534
Name:ROBINSON, TRACI DIANE (RPH)
Entity type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:DIANE
Last Name:ROBINSON
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 1:449 COMMERCE DR
Mailing Address - Street 2:T-2406
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4872
Mailing Address - Country:US
Mailing Address - Phone:651-239-1875
Mailing Address - Fax:651-239-1885
Practice Address - Street 1:449 COMMERCE DR
Practice Address - Street 2:T-2406
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4872
Practice Address - Country:US
Practice Address - Phone:651-239-1875
Practice Address - Fax:651-239-1885
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist