Provider Demographics
NPI:1073761425
Name:RICHARDSON, STACIE MARIE (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:MARIE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-2092
Mailing Address - Country:US
Mailing Address - Phone:508-485-0432
Mailing Address - Fax:508-485-0432
Practice Address - Street 1:515 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-2092
Practice Address - Country:US
Practice Address - Phone:508-485-0432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47088183500000X
MAPH27626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist