Provider Demographics
NPI:1285140145
Name:KEMMIS, STACEY ANN (PHARMD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:ANN
Last Name:KEMMIS
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 1:1201 29TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-9179
Mailing Address - Country:US
Mailing Address - Phone:605-886-8419
Mailing Address - Fax:
Practice Address - Street 1:1201 29TH ST SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-9179
Practice Address - Country:US
Practice Address - Phone:605-886-8419
Practice Address - Fax:605-886-0497
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120775183500000X
NDRPH5405183500000X
SDR6018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist