Provider Demographics
NPI:1982004834
Name:BECKER, STACY (RPH)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:BECKER
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 1:467 MCDONALD DR
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-5310
Mailing Address - Country:US
Mailing Address - Phone:304-264-9008
Mailing Address - Fax:304-267-8296
Practice Address - Street 1:1297 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405
Practice Address - Country:US
Practice Address - Phone:304-264-9008
Practice Address - Fax:304-267-8296
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV5750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist