Provider Demographics
NPI:1811298797
Name:HEATH, STACIE D (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STACIE
Middle Name:D
Last Name:HEATH
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 1:131 OYSTER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-4157
Mailing Address - Country:US
Mailing Address - Phone:979-292-0328
Mailing Address - Fax:979-297-8918
Practice Address - Street 1:131 OYSTER CREEK DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4157
Practice Address - Country:US
Practice Address - Phone:979-292-0328
Practice Address - Fax:979-297-8918
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist