Provider Demographics
NPI:1659672848
Name:STUNTZ, STACY JO
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:JO
Last Name:STUNTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 MAIN ST
Mailing Address - Street 2:SAFEWAY PHARMACY
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5993
Mailing Address - Country:US
Mailing Address - Phone:970-674-1188
Mailing Address - Fax:970-674-1141
Practice Address - Street 1:1535 MAIN ST
Practice Address - Street 2:SAFEWAY PHARMACY
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5993
Practice Address - Country:US
Practice Address - Phone:970-674-1188
Practice Address - Fax:970-674-1141
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist