Provider Demographics
NPI:1851743298
Name:CARELLI, TRACI (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:CARELLI
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 1:285 PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WEST LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03784-2029
Mailing Address - Country:US
Mailing Address - Phone:603-298-9680
Mailing Address - Fax:603-298-9682
Practice Address - Street 1:285 PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:WEST LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784-2029
Practice Address - Country:US
Practice Address - Phone:603-298-9680
Practice Address - Fax:603-298-9682
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3921183500000X
MAPH234810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist