Provider Demographics
NPI:1992843114
Name:WADHWANI, TRACY D (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:D
Last Name:WADHWANI
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 1:4102 S REGAL ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-7737
Mailing Address - Country:US
Mailing Address - Phone:509-535-2277
Mailing Address - Fax:
Practice Address - Street 1:3104 S REGAL ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4733
Practice Address - Country:US
Practice Address - Phone:509-535-2277
Practice Address - Fax:509-535-5966
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00019706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist