Provider Demographics
NPI:1609320738
Name:DAVIS, STACIE BROOKE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:BROOKE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:STACIE
Other - Middle Name:DAVIS
Other - Last Name:TURBERVILLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:GROVE HILL
Mailing Address - State:AL
Mailing Address - Zip Code:36451-0790
Mailing Address - Country:US
Mailing Address - Phone:251-275-3669
Mailing Address - Fax:251-275-8190
Practice Address - Street 1:123 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:GROVE HILL
Practice Address - State:AL
Practice Address - Zip Code:36451-3007
Practice Address - Country:US
Practice Address - Phone:251-275-3669
Practice Address - Fax:251-275-8190
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL17836OtherSTATE OF ALABAMA PHARMACY LICENSE