Provider Demographics
NPI:1942573910
Name:SCHMALTZ, TRACEY A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:A
Last Name:SCHMALTZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 TROSPER RD SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7375
Mailing Address - Country:US
Mailing Address - Phone:360-753-7933
Mailing Address - Fax:360-753-7927
Practice Address - Street 1:555 TROSPER RD SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7375
Practice Address - Country:US
Practice Address - Phone:360-753-7933
Practice Address - Fax:360-753-7927
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00019036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist