Provider Demographics
NPI:1821636093
Name:KRUEGER, TRACY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:M
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:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:VELVA
Mailing Address - State:ND
Mailing Address - Zip Code:58790-0054
Mailing Address - Country:US
Mailing Address - Phone:701-720-6187
Mailing Address - Fax:
Practice Address - Street 1:16 MAIN ST N
Practice Address - Street 2:
Practice Address - City:VELVA
Practice Address - State:ND
Practice Address - Zip Code:58790-7303
Practice Address - Country:US
Practice Address - Phone:701-338-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH5420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist