Provider Demographics
NPI:1417383480
Name:TADANO, TRACI (PHARM D)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:TADANO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 TENNYSON ST NE APT 1305
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-8178
Mailing Address - Country:US
Mailing Address - Phone:575-418-1227
Mailing Address - Fax:
Practice Address - Street 1:7847 TRAMWAY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2515
Practice Address - Country:US
Practice Address - Phone:505-821-5422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-22
Last Update Date:2013-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM8013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist