Provider Demographics
NPI:1235363912
Name:ARSENAULT, STACY M (BS)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:M
Last Name:ARSENAULT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-4341
Mailing Address - Country:US
Mailing Address - Phone:508-636-5957
Mailing Address - Fax:
Practice Address - Street 1:784 MAIN RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-4341
Practice Address - Country:US
Practice Address - Phone:508-636-5957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH21558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist