Provider Demographics
NPI:1770654071
Name:SCHMIDT, STACEY LOUISE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:LOUISE
Last Name:SCHMIDT
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:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98577-0591
Mailing Address - Country:US
Mailing Address - Phone:360-942-2634
Mailing Address - Fax:360-942-5132
Practice Address - Street 1:515 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:WA
Practice Address - Zip Code:98577-2509
Practice Address - Country:US
Practice Address - Phone:360-942-2634
Practice Address - Fax:360-942-5132
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00068595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist