Provider Demographics
NPI:1275134769
Name:CALDWELL, STACEY ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ANN
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:ANN
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:960 MEGAN LN
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-7650
Mailing Address - Country:US
Mailing Address - Phone:270-576-1696
Mailing Address - Fax:
Practice Address - Street 1:1650 EDMONTON RD
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167-9403
Practice Address - Country:US
Practice Address - Phone:270-487-0791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist