Provider Demographics
NPI:1609122332
Name:THRASH, STACY THERRELL (PHARM,D,)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:THERRELL
Last Name:THRASH
Suffix:
Gender:F
Credentials:PHARM,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 HILL ST
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39437-2419
Mailing Address - Country:US
Mailing Address - Phone:601-477-3573
Mailing Address - Fax:601-477-3572
Practice Address - Street 1:915 HILL ST
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39437-2419
Practice Address - Country:US
Practice Address - Phone:601-545-2056
Practice Address - Fax:601-545-3945
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-12598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist