Provider Demographics
NPI:1619291804
Name:ENGELBERG, STACEY LEIGH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:LEIGH
Last Name:ENGELBERG
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 1:3663 HILL BLVD
Mailing Address - Street 2:JEFFERSON VALLEY PHARMACY
Mailing Address - City:JEFFERSON VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10535
Mailing Address - Country:US
Mailing Address - Phone:914-962-6553
Mailing Address - Fax:914-962-6228
Practice Address - Street 1:3663 HILL BLVD
Practice Address - Street 2:JEFFERSON VALLEY PHARMACY
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535
Practice Address - Country:US
Practice Address - Phone:914-962-6553
Practice Address - Fax:914-962-6228
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042778183500000X
FLPS28992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist