Provider Demographics
NPI:1740811108
Name:SIZEMORE, STACIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:
Last Name:SIZEMORE
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 1:9852 HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:SALLIS
Mailing Address - State:MS
Mailing Address - Zip Code:39160-5774
Mailing Address - Country:US
Mailing Address - Phone:601-260-4549
Mailing Address - Fax:
Practice Address - Street 1:102 COURT SQ
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-3626
Practice Address - Country:US
Practice Address - Phone:662-834-2721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE8351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist