Provider Demographics
NPI:1902137730
Name:COMSTOCK, TRACEE M (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TRACEE
Middle Name:M
Last Name:COMSTOCK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18600 S NOGALES HWY
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-5284
Mailing Address - Country:US
Mailing Address - Phone:520-204-1092
Mailing Address - Fax:520-204-1095
Practice Address - Street 1:18600 S NOGALES HWY
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85614-5284
Practice Address - Country:US
Practice Address - Phone:520-204-1092
Practice Address - Fax:520-204-1095
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist