Provider Demographics
NPI:1326356528
Name:SHIPMAN, STACI L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STACI
Middle Name:L
Last Name:SHIPMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13210 N WINTZELL AVE
Mailing Address - Street 2:
Mailing Address - City:BAYOU LA BATRE
Mailing Address - State:AL
Mailing Address - Zip Code:36509-2142
Mailing Address - Country:US
Mailing Address - Phone:251-824-1702
Mailing Address - Fax:251-824-1705
Practice Address - Street 1:13210 N WINTZELL AVE
Practice Address - Street 2:
Practice Address - City:BAYOU LA BATRE
Practice Address - State:AL
Practice Address - Zip Code:36509-2142
Practice Address - Country:US
Practice Address - Phone:251-824-1702
Practice Address - Fax:251-824-1705
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16385183500000X
MSE09599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist