Provider Demographics
NPI:1811598170
Name:CHERNE, TRACI LEE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TRACI
Middle Name:LEE
Last Name:CHERNE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 N SHAWANO ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:WI
Mailing Address - Zip Code:54961-9365
Mailing Address - Country:US
Mailing Address - Phone:920-982-7906
Mailing Address - Fax:
Practice Address - Street 1:1717 N SHAWANO ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-9365
Practice Address - Country:US
Practice Address - Phone:920-982-7906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12603-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist