Provider Demographics
NPI:1053493023
Name:SOUERDYKE, STACY LYNNE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:LYNNE
Last Name:SOUERDYKE
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 1:5500 ROAD M
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:NE
Mailing Address - Zip Code:68370-1059
Mailing Address - Country:US
Mailing Address - Phone:402-365-7248
Mailing Address - Fax:
Practice Address - Street 1:348 N CENTRAL AVE
Practice Address - Street 2:SUPERIOR PHARMACY
Practice Address - City:SUPERIOR
Practice Address - State:NE
Practice Address - Zip Code:68978-1715
Practice Address - Country:US
Practice Address - Phone:402-879-4234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist