Provider Demographics
NPI:1235261777
Name:REILLY, STACEY JOY (RPH)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:JOY
Last Name:REILLY
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 1:5094 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:AMENIA
Mailing Address - State:NY
Mailing Address - Zip Code:12501
Mailing Address - Country:US
Mailing Address - Phone:845-373-8000
Mailing Address - Fax:
Practice Address - Street 1:5094 ROUTE 22
Practice Address - Street 2:
Practice Address - City:AMENIA
Practice Address - State:NY
Practice Address - Zip Code:12501
Practice Address - Country:US
Practice Address - Phone:845-373-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist