Provider Demographics
NPI:1821204025
Name:BENOIT, STACY C (RPH)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:C
Last Name:BENOIT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 LEE ROAD 997
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36870-9113
Mailing Address - Country:US
Mailing Address - Phone:334-291-4257
Mailing Address - Fax:334-291-4251
Practice Address - Street 1:1810 STADIUM DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-3100
Practice Address - Country:US
Practice Address - Phone:334-291-4257
Practice Address - Fax:334-291-4251
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist