Provider Demographics
NPI:1487938478
Name:SHIFLETT, TRACY (RPH)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:SHIFLETT
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 1:2820 N ASTOR ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-2112
Mailing Address - Country:US
Mailing Address - Phone:509-838-4826
Mailing Address - Fax:
Practice Address - Street 1:2820 N ASTOR ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2112
Practice Address - Country:US
Practice Address - Phone:509-838-4826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000522811835G0303X, 183500000X
TX31818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric