Provider Demographics
NPI:1629305354
Name:SHOEN, STACY MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MICHELLE
Last Name:SHOEN
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 1:200 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-9237
Mailing Address - Country:US
Mailing Address - Phone:989-362-9466
Mailing Address - Fax:989-362-9261
Practice Address - Street 1:200 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9237
Practice Address - Country:US
Practice Address - Phone:989-362-9466
Practice Address - Fax:989-362-9261
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist