Provider Demographics
NPI:1144598186
Name:VILVENS, TRACY (RPH)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:VILVENS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1425 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3069
Mailing Address - Country:US
Mailing Address - Phone:740-366-7119
Mailing Address - Fax:740-366-9903
Practice Address - Street 1:1425 N 21ST ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3069
Practice Address - Country:US
Practice Address - Phone:740-366-7119
Practice Address - Fax:740-366-9903
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH27722183500000X
TN11762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist