Provider Demographics
NPI:1891044319
Name:JAGLOWITZ, TRACEY A (PHARMD, RPH, PHC, MS)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:A
Last Name:JAGLOWITZ
Suffix:
Gender:F
Credentials:PHARMD, RPH, PHC, MS
Other - Prefix:DR
Other - First Name:TRACEY
Other - Middle Name:A
Other - Last Name:BARBERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7356 VISTA DE SOBRE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-0714
Mailing Address - Country:US
Mailing Address - Phone:505-554-0488
Mailing Address - Fax:
Practice Address - Street 1:2711 N TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8202
Practice Address - Country:US
Practice Address - Phone:575-521-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007713183500000X
NMPC000003131835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist