Provider Demographics
NPI:1831322510
Name:SMALL, TRACY WASHBURN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:WASHBURN
Last Name:SMALL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 WATERFRONT DR E
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120-5004
Mailing Address - Country:US
Mailing Address - Phone:412-464-2623
Mailing Address - Fax:412-464-2623
Practice Address - Street 1:1500 5TH AVE
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-2422
Practice Address - Country:US
Practice Address - Phone:412-464-2623
Practice Address - Fax:412-464-2623
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041000L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist