Provider Demographics
NPI:1770031361
Name:NYQUIST, STACEY LEIGH (PHARM D)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LEIGH
Last Name:NYQUIST
Suffix:
Gender:F
Credentials:PHARM D
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 309
Mailing Address - Street 2:
Mailing Address - City:LINDSBORG
Mailing Address - State:KS
Mailing Address - Zip Code:67456-0309
Mailing Address - Country:US
Mailing Address - Phone:785-227-3374
Mailing Address - Fax:785-227-2509
Practice Address - Street 1:605 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:LINDSBORG
Practice Address - State:KS
Practice Address - Zip Code:67456-2328
Practice Address - Country:US
Practice Address - Phone:785-227-3374
Practice Address - Fax:785-227-2509
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist