Provider Demographics
NPI:1215195524
Name:THOMPSON, STACEY M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:M
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:516 NIZHONI BLVD
Mailing Address - Street 2:BOX 1337
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5748
Mailing Address - Country:US
Mailing Address - Phone:505-722-1185
Mailing Address - Fax:
Practice Address - Street 1:516 NIZHONI BLVD
Practice Address - Street 2:BOX 1337
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5748
Practice Address - Country:US
Practice Address - Phone:505-722-1185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist