Provider Demographics
NPI:1770119042
Name:DEAN, STACEY RENEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:RENEE
Last Name:DEAN
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 1:2116 W LABURNUM AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-4359
Mailing Address - Country:US
Mailing Address - Phone:804-254-3559
Mailing Address - Fax:804-254-1616
Practice Address - Street 1:2116 W LABURNUM AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-4359
Practice Address - Country:US
Practice Address - Phone:804-254-3559
Practice Address - Fax:804-254-1616
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022079751835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory CareGroup - Single Specialty