Provider Demographics
NPI:1972122521
Name:RULLI, TRACY NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:NICOLE
Last Name:RULLI
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 1:4602 94TH PL
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-6230
Mailing Address - Country:US
Mailing Address - Phone:515-314-9119
Mailing Address - Fax:
Practice Address - Street 1:8701 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-2200
Practice Address - Country:US
Practice Address - Phone:515-270-2225
Practice Address - Fax:515-270-2227
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist