Provider Demographics
NPI:1487741153
Name:BRANDT, STACEY MALINDA (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:MALINDA
Last Name:BRANDT
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 1:9463 SAVANNAH ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6987
Mailing Address - Country:US
Mailing Address - Phone:561-964-1889
Mailing Address - Fax:
Practice Address - Street 1:2528 NW 19TH ST
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-5229
Practice Address - Country:US
Practice Address - Phone:954-876-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS36767OtherLICENSE NUMBER