Provider Demographics
NPI:1710423900
Name:PULIS, STACY E (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:E
Last Name:PULIS
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 1:26 BROADVIEW EST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-9405
Mailing Address - Country:US
Mailing Address - Phone:802-771-8651
Mailing Address - Fax:
Practice Address - Street 1:308 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4919
Practice Address - Country:US
Practice Address - Phone:802-864-8154
Practice Address - Fax:802-660-8774
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0123314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist