Provider Demographics
NPI:1700051547
Name:STACEY, MARLENE M (RPH)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:M
Last Name:STACEY
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 1:1322 PASA TIEMPO
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3639
Mailing Address - Country:US
Mailing Address - Phone:512-260-4179
Mailing Address - Fax:
Practice Address - Street 1:651 N HWY 183
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-7001
Practice Address - Country:US
Practice Address - Phone:512-528-7777
Practice Address - Fax:512-528-7780
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203791835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist