Provider Demographics
NPI:1750609368
Name:ETLING, TRACY (RPH)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:ETLING
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 1:1750 HIGHLAND RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2275
Mailing Address - Country:US
Mailing Address - Phone:800-643-5523
Mailing Address - Fax:800-533-7114
Practice Address - Street 1:1750 HIGHLAND RD
Practice Address - Street 2:SUITE F
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2275
Practice Address - Country:US
Practice Address - Phone:800-643-5523
Practice Address - Fax:800-533-7114
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03221194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist