Provider Demographics
NPI:1629471347
Name:KRUEGER, TRACY (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-2242
Mailing Address - Country:US
Mailing Address - Phone:608-269-7843
Mailing Address - Fax:608-269-7831
Practice Address - Street 1:1600 W WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-2242
Practice Address - Country:US
Practice Address - Phone:608-269-7843
Practice Address - Fax:608-269-7831
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14188-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist