Provider Demographics
NPI:1033408893
Name:NGUYEN, TRACY (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 GRAFTON ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-2365
Mailing Address - Country:US
Mailing Address - Phone:508-798-9394
Mailing Address - Fax:
Practice Address - Street 1:5 SHREWSBURY ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1959
Practice Address - Country:US
Practice Address - Phone:508-829-6504
Practice Address - Fax:508-829-7890
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45977183500000X
MAPH27289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist