Provider Demographics
NPI:1861512238
Name:DANSBERRY, TRACI YVONNE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:YVONNE
Last Name:DANSBERRY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4534 CAMBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8714
Mailing Address - Country:US
Mailing Address - Phone:636-477-1989
Mailing Address - Fax:636-447-4942
Practice Address - Street 1:7909 HWY N
Practice Address - Street 2:
Practice Address - City:DARDENNE PRAIRIE
Practice Address - State:MO
Practice Address - Zip Code:63368
Practice Address - Country:US
Practice Address - Phone:636-561-8450
Practice Address - Fax:636-561-8455
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO045213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist