Provider Demographics
NPI:1104191014
Name:THANG, TRACY KHANH (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:KHANH
Last Name:THANG
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 1:12155 TECH CENTER DR
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-7156
Mailing Address - Country:US
Mailing Address - Phone:858-848-2478
Mailing Address - Fax:858-848-2475
Practice Address - Street 1:12155 TECH CENTER DR
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-7156
Practice Address - Country:US
Practice Address - Phone:858-848-2478
Practice Address - Fax:858-848-2475
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist