Provider Demographics
NPI:1073936019
Name:ZOLLDAN, STACY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:ZOLLDAN
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 1:13494 LODESTAR DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-8362
Mailing Address - Country:US
Mailing Address - Phone:530-559-5484
Mailing Address - Fax:
Practice Address - Street 1:13494 LODESTAR DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-8362
Practice Address - Country:US
Practice Address - Phone:530-559-5484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA466531835P0018X
NV109271835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist