Provider Demographics
NPI:1073110755
Name:RHEE, TRACY NALLI
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:NALLI
Last Name:RHEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7507 HAVELOCK ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-3920
Mailing Address - Country:US
Mailing Address - Phone:703-901-0104
Mailing Address - Fax:
Practice Address - Street 1:3401 CHARLES ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-1901
Practice Address - Country:US
Practice Address - Phone:703-933-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist