Provider Demographics
NPI:1871825810
Name:CARBONETTO, TRACEY M (RPH)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:M
Last Name:CARBONETTO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:M
Other - Last Name:MCELHINEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:625 STATE ST
Mailing Address - Street 2:C/O MVP HEALTH CARE
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-2111
Mailing Address - Country:US
Mailing Address - Phone:518-836-3137
Mailing Address - Fax:
Practice Address - Street 1:625 STATE ST
Practice Address - Street 2:C/O MVP HEALTH CARE
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-2111
Practice Address - Country:US
Practice Address - Phone:518-836-3137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044607-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist