Provider Demographics
NPI:1679814008
Name:WILCOX, STACEY LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LEE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LEE
Other - Last Name:PUCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:22370 DAVIS DR STE 190
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-5367
Mailing Address - Country:US
Mailing Address - Phone:703-466-4900
Mailing Address - Fax:703-466-4901
Practice Address - Street 1:22370 DAVIS DR STE 190
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-5367
Practice Address - Country:US
Practice Address - Phone:703-466-4900
Practice Address - Fax:703-466-4901
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist