Provider Demographics
NPI:1740882414
Name:FOLSOM, STACY MELODY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:MELODY
Last Name:FOLSOM
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 1:3559 ANTIOCH GREGGS RD
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620-9647
Mailing Address - Country:US
Mailing Address - Phone:229-891-8985
Mailing Address - Fax:
Practice Address - Street 1:641 VETERANS PKWY S
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31788-8843
Practice Address - Country:US
Practice Address - Phone:229-985-6850
Practice Address - Fax:229-985-9421
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist