Provider Demographics
NPI:1497583629
Name:BEDARD, TRACY ANNE
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ANNE
Last Name:BEDARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:ANNE
Other - Last Name:FONTAINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 WALLACE RD
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045-1824
Mailing Address - Country:US
Mailing Address - Phone:603-660-2980
Mailing Address - Fax:
Practice Address - Street 1:1298 HOOKSETT RD
Practice Address - Street 2:
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-1842
Practice Address - Country:US
Practice Address - Phone:603-647-2846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist