Provider Demographics
NPI:1720455751
Name:BARTHOLOMEW, TRACEY (PH00059689)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:PH00059689
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 BRIDGEPORT WAY W
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8099
Mailing Address - Country:US
Mailing Address - Phone:253-512-0960
Mailing Address - Fax:
Practice Address - Street 1:7001 BRIDGEPORT WAY W
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-512-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00059689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist