Provider Demographics
NPI:1639447816
Name:ECKERMAN, STACY A (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:A
Last Name:ECKERMAN
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 1:1250 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-3138
Mailing Address - Country:US
Mailing Address - Phone:970-787-6550
Mailing Address - Fax:970-787-6551
Practice Address - Street 1:1250 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-3138
Practice Address - Country:US
Practice Address - Phone:970-787-6550
Practice Address - Fax:970-787-6551
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist