Provider Demographics
NPI:1649872276
Name:STAFFORD, TRACIE SAMANTHA (RPH)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:SAMANTHA
Last Name:STAFFORD
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 1:8223 ELLIOTT RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2956
Mailing Address - Country:US
Mailing Address - Phone:410-819-3215
Mailing Address - Fax:844-411-6301
Practice Address - Street 1:8223 ELLIOTT RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2956
Practice Address - Country:US
Practice Address - Phone:410-819-3215
Practice Address - Fax:844-411-6301
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist