Provider Demographics
NPI:1992067268
Name:WOODS, STACIE ANN
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:ANN
Last Name:WOODS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9579 BRADDOCK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-2539
Mailing Address - Country:US
Mailing Address - Phone:703-978-0661
Mailing Address - Fax:703-978-1831
Practice Address - Street 1:9579 BRADDOCK RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-2539
Practice Address - Country:US
Practice Address - Phone:703-978-0661
Practice Address - Fax:703-978-1831
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist