Provider Demographics
NPI:1184231490
Name:TOUMBLESTON, STACY JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:TOUMBLESTON
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 COULTER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-4515
Mailing Address - Country:US
Mailing Address - Phone:770-596-8640
Mailing Address - Fax:
Practice Address - Street 1:1602 N EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-1269
Practice Address - Country:US
Practice Address - Phone:770-227-3397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist