Provider Demographics
NPI:1922433473
Name:CLARK, TRACY SUE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:SUE
Last Name:CLARK
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 1:7425 WRIGLEY DR
Mailing Address - Street 2:STE 104
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5292
Mailing Address - Country:US
Mailing Address - Phone:509-546-8388
Mailing Address - Fax:509-546-8369
Practice Address - Street 1:7425 WRIGLEY DR
Practice Address - Street 2:STE 104
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5292
Practice Address - Country:US
Practice Address - Phone:509-546-8388
Practice Address - Fax:509-546-8369
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000216131835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy