Provider Demographics
NPI:1689274615
Name:BLANCHARD, TRACY RENEE
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:RENEE
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:RENEE
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1716 HERITAGE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-6066
Mailing Address - Country:US
Mailing Address - Phone:513-907-6098
Mailing Address - Fax:
Practice Address - Street 1:1274 E 2ND ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-1994
Practice Address - Country:US
Practice Address - Phone:937-704-0697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03227927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist