Provider Demographics
NPI:1568731461
Name:EISELE, STACY (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:EISELE
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 1:2651 CAPITOL TRL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7242
Mailing Address - Country:US
Mailing Address - Phone:302-453-1010
Mailing Address - Fax:
Practice Address - Street 1:2651 CAPITOL TRL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7242
Practice Address - Country:US
Practice Address - Phone:302-453-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP046359183500000X
DEA1-0003308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist