Provider Demographics
NPI:1386198893
Name:TRACY, NICHOLAS BRADFORD (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:BRADFORD
Last Name:TRACY
Suffix:
Gender:M
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 1:3301 E RAY RD APT 2051
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4561
Mailing Address - Country:US
Mailing Address - Phone:863-513-2305
Mailing Address - Fax:
Practice Address - Street 1:3230 E CHANDLER HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4261
Practice Address - Country:US
Practice Address - Phone:480-214-4894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist