Provider Demographics
NPI:1437106234
Name:RICHIE, TRACEY ANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:ANNE
Last Name:RICHIE
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 1:5825 MY WAY LN
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-3617
Mailing Address - Country:US
Mailing Address - Phone:804-693-4996
Mailing Address - Fax:
Practice Address - Street 1:77 NEALY AVENUE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666
Practice Address - Country:US
Practice Address - Phone:757-764-6758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPCT.6990OtherPHARMACIST LICENSE
VA0202010542OtherPHARMACIST LICENSE