Provider Demographics
NPI:1831087535
Name:DALTON, TRACY VIRGINIA (PHARMD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:VIRGINIA
Last Name:DALTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:VIRGINIA
Other - Last Name:DROTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2789 PRAIRIE GARDEN TRL
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-3958
Mailing Address - Country:US
Mailing Address - Phone:262-989-0607
Mailing Address - Fax:
Practice Address - Street 1:464 CARDINAL LN
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-9569
Practice Address - Country:US
Practice Address - Phone:920-661-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist