Provider Demographics
NPI:1275133654
Name:FALISEC, TRACY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:FALISEC
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 1:3100 OAKLAND AVE STE 1C
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3277
Mailing Address - Country:US
Mailing Address - Phone:724-349-5759
Mailing Address - Fax:724-465-9403
Practice Address - Street 1:3100 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3240
Practice Address - Country:US
Practice Address - Phone:724-349-5759
Practice Address - Fax:724-465-9403
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044885L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist