Provider Demographics
NPI:1184994626
Name:VREHAS, TRACI BETH (RPH)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:BETH
Last Name:VREHAS
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 1:8845 KENNEDY AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-1908
Mailing Address - Country:US
Mailing Address - Phone:219-972-1700
Mailing Address - Fax:
Practice Address - Street 1:8845 KENNEDY AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-1908
Practice Address - Country:US
Practice Address - Phone:219-972-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051289396183500000X
MO2001030596183500000X
FLPS40602183500000X
IN26026005A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist