Provider Demographics
NPI:1952684649
Name:JAY, STACIE J (RPH)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:J
Last Name:JAY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2048 WRANGLER CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-9777
Mailing Address - Country:US
Mailing Address - Phone:970-208-1252
Mailing Address - Fax:970-208-1258
Practice Address - Street 1:240 W PARK DR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1450
Practice Address - Country:US
Practice Address - Phone:970-208-1252
Practice Address - Fax:970-208-1258
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO13536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist