Provider Demographics
NPI:1093797490
Name:KLINE, STACEY SUE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:SUE
Last Name:KLINE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:SUE
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:340 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1529
Mailing Address - Country:US
Mailing Address - Phone:330-253-3600
Mailing Address - Fax:
Practice Address - Street 1:340 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1529
Practice Address - Country:US
Practice Address - Phone:330-253-3600
Practice Address - Fax:330-253-3601
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-26356183500000X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric