Provider Demographics
NPI:1902825813
Name:DAVIS, STACY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:DAVIS
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 1:16914 BRIGADOON TRL
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-8254
Mailing Address - Country:US
Mailing Address - Phone:251-978-3877
Mailing Address - Fax:
Practice Address - Street 1:34023 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:LILLIAN
Practice Address - State:AL
Practice Address - Zip Code:36549-4053
Practice Address - Country:US
Practice Address - Phone:251-962-3777
Practice Address - Fax:251-962-3779
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist