Provider Demographics
NPI:1851930887
Name:DINH, TRACY PHUONG (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:PHUONG
Last Name:DINH
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 1:115 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BATESBURG LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29070-7595
Mailing Address - Country:US
Mailing Address - Phone:803-532-5226
Mailing Address - Fax:
Practice Address - Street 1:115 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:BATESBURG LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070-7595
Practice Address - Country:US
Practice Address - Phone:803-532-5226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist