Provider Demographics
NPI:1588008486
Name:MCSHANE, STACY J (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:J
Last Name:MCSHANE
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 1:900 BANK CT
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52213-9477
Mailing Address - Country:US
Mailing Address - Phone:319-849-2799
Mailing Address - Fax:319-849-1536
Practice Address - Street 1:900 BANK CT
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:IA
Practice Address - Zip Code:52213-9477
Practice Address - Country:US
Practice Address - Phone:319-849-2799
Practice Address - Fax:319-849-1536
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist