Provider Demographics
NPI:1689795049
Name:SOPPE, STACY NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:NICOLE
Last Name:SOPPE
Suffix:
Gender:F
Credentials:PHARMD
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Other - Credentials:
Mailing Address - Street 1:2900 W OKLAHOMA AVE
Mailing Address - Street 2:OUTPATIENT PHARMACY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4330
Mailing Address - Country:US
Mailing Address - Phone:414-649-6063
Mailing Address - Fax:414-649-5367
Practice Address - Street 1:2801 W KINNICKINNIC RIVER PKWY
Practice Address - Street 2:FAMILY PRACTICE CLINIC ANTICOAGULATION CLINIC
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3669
Practice Address - Country:US
Practice Address - Phone:414-649-7810
Practice Address - Fax:414-649-5437
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI13742-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist