Provider Demographics
NPI:1710139522
Name:MOONEY, STACEY MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:MARIE
Last Name:MOONEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 HUDSON HARBOUR DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5322
Mailing Address - Country:US
Mailing Address - Phone:845-893-7512
Mailing Address - Fax:
Practice Address - Street 1:48 E MARKET ST
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1606
Practice Address - Country:US
Practice Address - Phone:845-876-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051498-1183500000X
CT10562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist