Provider Demographics
NPI:1023390689
Name:SIMS, STACYE L (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACYE
Middle Name:L
Last Name:SIMS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 CENTRAL PIKE
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3156
Mailing Address - Country:US
Mailing Address - Phone:615-874-8399
Mailing Address - Fax:615-874-9496
Practice Address - Street 1:4001 CENTRAL PIKE
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3156
Practice Address - Country:US
Practice Address - Phone:615-874-8399
Practice Address - Fax:615-874-9496
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist