Provider Demographics
NPI:1720535529
Name:ZOBLISEIN, TRACY (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:ZOBLISEIN
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 1:790 CHURCH ST NE
Mailing Address - Street 2:SUITE 335
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7282
Mailing Address - Country:US
Mailing Address - Phone:770-590-8311
Mailing Address - Fax:770-590-8313
Practice Address - Street 1:790 CHURCH ST NE
Practice Address - Street 2:SUITE 335
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7282
Practice Address - Country:US
Practice Address - Phone:770-590-8311
Practice Address - Fax:770-590-8313
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0195821835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology