Provider Demographics
NPI:1164742235
Name:KADURA, TRACIE POE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:POE
Last Name:KADURA
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:RED ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78662-0068
Mailing Address - Country:US
Mailing Address - Phone:512-461-9914
Mailing Address - Fax:512-332-0422
Practice Address - Street 1:104 N HASLER BLVD
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3740
Practice Address - Country:US
Practice Address - Phone:512-581-7044
Practice Address - Fax:512-332-0422
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist