Provider Demographics
NPI:1023394624
Name:SCHNEIDER, TRACY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:SCHNEIDER
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 1:2500 BLAINE ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4461
Mailing Address - Country:US
Mailing Address - Phone:208-454-0484
Mailing Address - Fax:208-454-3115
Practice Address - Street 1:2500 BLAINE ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605
Practice Address - Country:US
Practice Address - Phone:208-454-0484
Practice Address - Fax:208-454-3115
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP5286OtherIDAHO BOARD OF PHARMACY
IDCS7256OtherCONTROLLED SUBSTANCE REGISTRATION