Provider Demographics
NPI:1124405170
Name:BONSU, TRACY (PHARMD RPH)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BONSU
Suffix:
Gender:F
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N COOPER STREET
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011
Mailing Address - Country:US
Mailing Address - Phone:469-438-7855
Mailing Address - Fax:469-283-2418
Practice Address - Street 1:1000 N COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5540
Practice Address - Country:US
Practice Address - Phone:817-548-3474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist