Provider Demographics
NPI:1659522209
Name:WORLEY, STACIE (RPH)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:WORLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 BUFORD HWY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3632
Mailing Address - Country:US
Mailing Address - Phone:770-945-4077
Mailing Address - Fax:770-932-3984
Practice Address - Street 1:1605 BUFORD HWY
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3632
Practice Address - Country:US
Practice Address - Phone:770-945-4077
Practice Address - Fax:770-932-3984
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist