Provider Demographics
NPI:1972637205
Name:CARTER, STACEY D (RPH)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:D
Last Name:CARTER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 CHARLES V ST
Mailing Address - Street 2:
Mailing Address - City:SATSUMA
Mailing Address - State:AL
Mailing Address - Zip Code:36572-2821
Mailing Address - Country:US
Mailing Address - Phone:251-679-9316
Mailing Address - Fax:251-937-1102
Practice Address - Street 1:710 MCMEANS AVE
Practice Address - Street 2:PHARMACY DEPT.
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-3348
Practice Address - Country:US
Practice Address - Phone:251-937-1101
Practice Address - Fax:251-937-1102
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL11806OtherSTATE LICENSE NUMBER