Provider Demographics
NPI:1265804421
Name:BARTON, TRACY (RPH)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BARTON
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 1:9900 SE SUNNYSIDE RD
Mailing Address - Street 2:SUNNYBROOK MEDICAL OFFICE, INFECTIOUS DISEASE DEPARTMEN
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9777
Mailing Address - Country:US
Mailing Address - Phone:503-571-9142
Mailing Address - Fax:503-571-8986
Practice Address - Street 1:9900 SE SUNNYSIDE RD
Practice Address - Street 2:SUNNYBROOK MEDICAL OFFICE, INFECTIOUS DISEASE DEPARTMEN
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9777
Practice Address - Country:US
Practice Address - Phone:503-571-9142
Practice Address - Fax:503-571-8986
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0007966183500000X
WI10555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist