Provider Demographics
NPI:1538198528
Name:KASDEN, TRACY L (PHARM D)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:L
Last Name:KASDEN
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 1:10661 BARDILINO ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-4266
Mailing Address - Country:US
Mailing Address - Phone:702-614-0923
Mailing Address - Fax:
Practice Address - Street 1:490 E SILVERADO RANCH BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-6290
Practice Address - Country:US
Practice Address - Phone:702-263-4270
Practice Address - Fax:702-263-7230
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist