Provider Demographics
NPI:1164609780
Name:TULOWIECKI, TRACY LYNN (RPH)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LYNN
Last Name:TULOWIECKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9021 CLEMENT CIR
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:NC
Mailing Address - Zip Code:28682-9718
Mailing Address - Country:US
Mailing Address - Phone:704-488-5413
Mailing Address - Fax:
Practice Address - Street 1:9021 CLEMENT CIR
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:NC
Practice Address - Zip Code:28682-9718
Practice Address - Country:US
Practice Address - Phone:704-488-5413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17458183500000X
NY44433183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist