Provider Demographics
NPI:1134926520
Name:PETERS, TRACI LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TRACI
Middle Name:LYNN
Last Name:PETERS
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:TRACI
Other - Middle Name:LYNN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:11531 SE ROSS RD
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-6440
Mailing Address - Country:US
Mailing Address - Phone:503-679-4505
Mailing Address - Fax:503-674-1169
Practice Address - Street 1:24988 SE STARK ST STE 320
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8325
Practice Address - Country:US
Practice Address - Phone:503-674-1229
Practice Address - Fax:503-674-1169
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORIND-9088531835P2201X
ORRPH-00096231835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care