Provider Demographics
NPI:1699378877
Name:GILES, STACY SHARP (RPH)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:SHARP
Last Name:GILES
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:PO BOX 1370
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-1370
Mailing Address - Country:US
Mailing Address - Phone:256-638-2255
Mailing Address - Fax:
Practice Address - Street 1:503 MAIN ST W
Practice Address - Street 2:
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986-5944
Practice Address - Country:US
Practice Address - Phone:256-638-2255
Practice Address - Fax:256-638-2257
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist