Provider Demographics
NPI:1861481046
Name:SANJUME, TRACIE L (PHARMD, BCPS, CDCES)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:L
Last Name:SANJUME
Suffix:
Gender:F
Credentials:PHARMD, BCPS, CDCES
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:L
Other - Last Name:SHIMIZU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD, BCPS, CDCES
Mailing Address - Street 1:NAVAL HEALTH CLINIC HAWAII
Mailing Address - Street 2:480 CENTRAL AVENUE
Mailing Address - City:PEARL HARBOR
Mailing Address - State:HI
Mailing Address - Zip Code:96860-4908
Mailing Address - Country:US
Mailing Address - Phone:808-473-1880
Mailing Address - Fax:808-473-4449
Practice Address - Street 1:480 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:JBPHH
Practice Address - State:HI
Practice Address - Zip Code:96860-4908
Practice Address - Country:US
Practice Address - Phone:808-473-1880
Practice Address - Fax:808-473-4449
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI23491835P1200X, 1835P0018X
CA537721835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy