Provider Demographics
NPI:1184044356
Name:SAUVIAC, STACEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:SAUVIAC
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 1:9550 MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-4402
Mailing Address - Country:US
Mailing Address - Phone:318-688-4151
Mailing Address - Fax:318-688-5610
Practice Address - Street 1:9550 MANSFIELD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-4402
Practice Address - Country:US
Practice Address - Phone:318-688-4151
Practice Address - Fax:318-688-5610
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist