Provider Demographics
NPI:1659394088
Name:BALVANZ, TRACIE MARIE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:MARIE
Last Name:BALVANZ
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 1:4776 SCENIC HILL CIR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-9403
Mailing Address - Country:US
Mailing Address - Phone:775-746-4845
Mailing Address - Fax:
Practice Address - Street 1:1000 LOCUST ST # 119
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2597
Practice Address - Country:US
Practice Address - Phone:775-328-1840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE121251835P0018X
NV168421835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist