Provider Demographics
NPI:1669743951
Name:DIGNEO, STACY L (PHARMD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:DIGNEO
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 1:20 CONESTOGA RD
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-5306
Mailing Address - Country:US
Mailing Address - Phone:609-330-2961
Mailing Address - Fax:
Practice Address - Street 1:820 COOPER ST
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-2598
Practice Address - Country:US
Practice Address - Phone:856-686-1382
Practice Address - Fax:856-686-1383
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03297200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist