Provider Demographics
NPI:1750667531
Name:BOYT, STACIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:BOYT
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 1:597 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30204-1577
Mailing Address - Country:US
Mailing Address - Phone:770-872-3924
Mailing Address - Fax:
Practice Address - Street 1:597 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30204-1577
Practice Address - Country:US
Practice Address - Phone:770-872-3924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020024183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist