Provider Demographics
NPI:1811464225
Name:PAFF, TRACI (PHARMD)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:PAFF
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W HOMER ST FL 1
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-4358
Mailing Address - Country:US
Mailing Address - Phone:219-878-8300
Mailing Address - Fax:219-878-8301
Practice Address - Street 1:301 W HOMER ST FL 1
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-4358
Practice Address - Country:US
Practice Address - Phone:219-878-8300
Practice Address - Fax:219-878-8301
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022511A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist