Provider Demographics
NPI:1518554799
Name:MERENDA, STACY ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:MERENDA
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 1:1117 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4965
Mailing Address - Country:US
Mailing Address - Phone:214-627-2143
Mailing Address - Fax:215-627-8943
Practice Address - Street 1:1117 WALNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4965
Practice Address - Country:US
Practice Address - Phone:214-627-2143
Practice Address - Fax:215-627-8943
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP04437L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist