Provider Demographics
NPI:1750802427
Name:OSPALEK, TRACI MARIE (RPH)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:MARIE
Last Name:OSPALEK
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 1:9 ERICA LN
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-1427
Mailing Address - Country:US
Mailing Address - Phone:203-879-2718
Mailing Address - Fax:
Practice Address - Street 1:410 REIDVILLE DR
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-2660
Practice Address - Country:US
Practice Address - Phone:203-755-5814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist