Provider Demographics
NPI:1821241076
Name:PECK, STACIE WILLIAMS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:WILLIAMS
Last Name:PECK
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 1:19010 GREENLEAF RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4590
Mailing Address - Country:US
Mailing Address - Phone:281-256-0440
Mailing Address - Fax:
Practice Address - Street 1:19010 GREENLEAF RIDGE CT
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4590
Practice Address - Country:US
Practice Address - Phone:281-256-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46386183500000X
LA018421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist