Provider Demographics
NPI:1538762877
Name:DANG, TRACEY TUYEN
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:TUYEN
Last Name:DANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NANCY CIR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3311
Mailing Address - Country:US
Mailing Address - Phone:617-306-1044
Mailing Address - Fax:
Practice Address - Street 1:261 CHAUNCY ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1247
Practice Address - Country:US
Practice Address - Phone:508-339-6711
Practice Address - Fax:508-337-8918
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA025858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist