Provider Demographics
NPI:1447424049
Name:WOODCOCK, STACIA ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STACIA
Middle Name:ANN
Last Name:WOODCOCK
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 1:5505 WOODSIDE AVE APT 318
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3303
Mailing Address - Country:US
Mailing Address - Phone:917-902-3471
Mailing Address - Fax:
Practice Address - Street 1:10718 70TH RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4262
Practice Address - Country:US
Practice Address - Phone:646-968-2872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH235496183500000X
NY049851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist