Provider Demographics
NPI:1912091802
Name:OSGOOD, TRACIE SANNICANDRO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRACIE
Middle Name:SANNICANDRO
Last Name:OSGOOD
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 1:25 COURTENAY DR
Mailing Address - Street 2:SECOND FLOOR ASHLEY RIVER TOWER PHARMACY
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8911
Mailing Address - Country:US
Mailing Address - Phone:843-876-5588
Mailing Address - Fax:
Practice Address - Street 1:25 COURTENAY DR
Practice Address - Street 2:SECOND FLOOR ASHLEY RIVER TOWER PHARMACY
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8911
Practice Address - Country:US
Practice Address - Phone:843-876-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0099471835G0303X, 1835P1200X
MA234311835G0303X, 1835P1200X
CT085031835G0303X
VA02022046871835G0303X, 1835P1200X
PARP-043684-R1835G0303X, 1835P1200X
CT85031835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric