Provider Demographics
NPI:1811387517
Name:LUNDBLAD, STACY (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:LUNDBLAD
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9205
Mailing Address - Country:US
Mailing Address - Phone:919-854-9436
Mailing Address - Fax:
Practice Address - Street 1:2021 WALNUT ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9205
Practice Address - Country:US
Practice Address - Phone:919-854-9436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09605183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician