Provider Demographics
NPI:1194048405
Name:DEAN, STACY D (PHARMD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:D
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 1:1169 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16933-9537
Mailing Address - Country:US
Mailing Address - Phone:570-662-1120
Mailing Address - Fax:570-662-1122
Practice Address - Street 1:1169 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-9537
Practice Address - Country:US
Practice Address - Phone:570-662-1120
Practice Address - Fax:570-662-1122
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP443949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist