Provider Demographics
NPI:1013142249
Name:PALMER, STACIE BOUDREAUX (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:BOUDREAUX
Last Name:PALMER
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 1:52160 NATIONAL RD E
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-9306
Mailing Address - Country:US
Mailing Address - Phone:740-695-7845
Mailing Address - Fax:740-695-5297
Practice Address - Street 1:52160 NATIONAL RD E
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-9306
Practice Address - Country:US
Practice Address - Phone:740-695-7845
Practice Address - Fax:740-695-5297
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03329317-3183500000X
WVRP0006097183500000X
LA16095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist