Provider Demographics
NPI:1841584877
Name:ALEXANDER, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7311 JEFFERSON BLVD
Mailing Address - Street 2:T1513
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-6178
Mailing Address - Country:US
Mailing Address - Phone:502-968-9256
Mailing Address - Fax:502-968-9256
Practice Address - Street 1:7311 JEFFERSON BLVD
Practice Address - Street 2:T1513
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-6178
Practice Address - Country:US
Practice Address - Phone:502-968-9256
Practice Address - Fax:502-968-9256
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist