Provider Demographics
NPI:1457689481
Name:RAHE, STACEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:RAHE
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 1:6200 W WILLIAM CANNON DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1794
Mailing Address - Country:US
Mailing Address - Phone:512-892-1933
Mailing Address - Fax:512-892-0765
Practice Address - Street 1:6200 W WILLIAM CANNON DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1794
Practice Address - Country:US
Practice Address - Phone:512-892-1933
Practice Address - Fax:512-892-0765
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist