Provider Demographics
NPI:1548371073
Name:MOORE, TRACEY LYNN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:LYNN
Last Name:MOORE
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 1:5684 MOONSTONE LOOP SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-3517
Mailing Address - Country:US
Mailing Address - Phone:503-362-2627
Mailing Address - Fax:
Practice Address - Street 1:5684 MOONSTONE LOOP SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-3517
Practice Address - Country:US
Practice Address - Phone:503-362-2627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00086511835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy