MEDICARE: MS. STACIE SUE COPELAND R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP0006029	WV

General Provider Information

NPI Number	:	1447605860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STACIE SUE COPELAND R.PH.

Provider Business Mailing Address
First Line	:	49288 GLENWILL DR
Second Line	:
City	:	SAINT CLAIRSVILLE
State	:	OH
Zip	:	43950-9360
Country	:	US
Telephone Number	:	740-449-2150
Fax Number	:

Provider Business Practice Location Address
First Line	:	50789 VALLEY PLAZA DR
Second Line	:
City	:	SAINT CLAIRSVILLE
State	:	OH
Zip	:	43950-1752
Country	:	US
Telephone Number	:	740-695-5088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2016
Last Update Date	:	05/04/2016

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