Provider Demographics
NPI:1376890350
Name:LIVINGSTON, STACY BROOKE (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:BROOKE
Last Name:LIVINGSTON
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 1:101 10TH ST E APT 248
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2556
Mailing Address - Country:US
Mailing Address - Phone:515-314-2428
Mailing Address - Fax:
Practice Address - Street 1:101 10TH ST E APT 248
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2556
Practice Address - Country:US
Practice Address - Phone:515-314-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16743-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist