Provider Demographics
NPI:1770843138
Name:RICHARD, STACY L (PHARM D)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:RICHARD
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 1:151 CRANE LN
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-7710
Mailing Address - Country:US
Mailing Address - Phone:985-852-1566
Mailing Address - Fax:
Practice Address - Street 1:815 BRASHEAR AVE
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1923
Practice Address - Country:US
Practice Address - Phone:985-384-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-19
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18860183500000X
AL16293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist