Provider Demographics
NPI:1003250028
Name:RHODES, TRACY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:RHODES
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 1:27468 CLOVERLEAF DR
Mailing Address - Street 2:#1135
Mailing Address - City:HELENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:92342-7747
Mailing Address - Country:US
Mailing Address - Phone:814-952-0208
Mailing Address - Fax:
Practice Address - Street 1:4013 PHELAN RD
Practice Address - Street 2:
Practice Address - City:PHELAN
Practice Address - State:CA
Practice Address - Zip Code:92371-8912
Practice Address - Country:US
Practice Address - Phone:760-868-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-21
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist