Provider Demographics
NPI:1295450518
Name:HALEY, STACIE (RPH)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:HALEY
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 1:24 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-1999
Mailing Address - Country:US
Mailing Address - Phone:508-393-6027
Mailing Address - Fax:508-393-0966
Practice Address - Street 1:24 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1999
Practice Address - Country:US
Practice Address - Phone:508-393-6027
Practice Address - Fax:508-393-0966
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty