Provider Demographics
NPI:1538300298
Name:WATERS, STACY MARIE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:MARIE
Last Name:WATERS
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 1:1032 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:OH
Mailing Address - Zip Code:45030-1522
Mailing Address - Country:US
Mailing Address - Phone:513-367-2127
Mailing Address - Fax:513-367-9516
Practice Address - Street 1:1032 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-1522
Practice Address - Country:US
Practice Address - Phone:513-367-2127
Practice Address - Fax:513-367-9516
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03328763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist