Provider Demographics
NPI:1881892164
Name:NELSON, STACIE THORNTON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STACIE
Middle Name:THORNTON
Last Name:NELSON
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 1:107 HIGHWAY 80 E
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4738
Mailing Address - Country:US
Mailing Address - Phone:601-832-0336
Mailing Address - Fax:601-925-6344
Practice Address - Street 1:107 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4738
Practice Address - Country:US
Practice Address - Phone:601-925-6343
Practice Address - Fax:601-925-6344
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST09286183500000X
MST-092861835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist