Provider Demographics
NPI:1952369993
Name:EDDY, TRACI L (RPH)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:L
Last Name:EDDY
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 1:1896 E 850TH RD
Mailing Address - Street 2:
Mailing Address - City:LECOMPTON
Mailing Address - State:KS
Mailing Address - Zip Code:66050-4061
Mailing Address - Country:US
Mailing Address - Phone:785-887-6862
Mailing Address - Fax:
Practice Address - Street 1:3401 SW 21ST ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3302
Practice Address - Country:US
Practice Address - Phone:785-350-3723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-11800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist