Provider Demographics
NPI:1093303620
Name:TREASURE, STACI K (RPH)
Entity Type:Individual
Prefix:MS
First Name:STACI
Middle Name:K
Last Name:TREASURE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CAVENDISH DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4647
Mailing Address - Country:US
Mailing Address - Phone:317-625-8384
Mailing Address - Fax:
Practice Address - Street 1:1000 CAVENDISH DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4647
Practice Address - Country:US
Practice Address - Phone:317-625-8384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX327493336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy