Provider Demographics
NPI:1063008977
Name:BOHLAND, STACIA L (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACIA
Middle Name:L
Last Name:BOHLAND
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 1:360 PEBBLE BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-8437
Mailing Address - Country:US
Mailing Address - Phone:317-340-5293
Mailing Address - Fax:
Practice Address - Street 1:6511 WHITESTOWN PKWY
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-7621
Practice Address - Country:US
Practice Address - Phone:317-340-5293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020934A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist