Provider Demographics
NPI:1588267587
Name:BOUCHER, STACY (PHARMD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:BOUCHER
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 1:181 HIGHWAY 84 W
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36322-9113
Mailing Address - Country:US
Mailing Address - Phone:334-598-4242
Mailing Address - Fax:
Practice Address - Street 1:181 HIGHWAY 84 W
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36322-9113
Practice Address - Country:US
Practice Address - Phone:334-598-4242
Practice Address - Fax:334-598-4240
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL14575OtherALABAMA STATE BOARD OF PHARMACY