Provider Demographics
NPI:1023450434
Name:PECCIA, STEPHANIE EVE (PHARMD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:EVE
Last Name:PECCIA
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 1:2303 AZALEA GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7913
Mailing Address - Country:US
Mailing Address - Phone:443-802-7368
Mailing Address - Fax:
Practice Address - Street 1:780 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7269
Practice Address - Country:US
Practice Address - Phone:770-422-2387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist