MEDICARE: STACEY LOVE

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	11086	TN

General Provider Information

NPI Number	:	1992915391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY LOVE

Provider Business Mailing Address
First Line	:	2420 WHORTON SPRINGS RD
Second Line	:
City	:	SMITHVILLE
State	:	TN
Zip	:	37166-6261
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2420 WHORTON SPRINGS RD
Second Line	:
City	:	SMITHVILLE
State	:	TN
Zip	:	37166-6261
Country	:	US
Telephone Number	:	931-808-1779
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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Directions to “ STACEY LOVE ” Practice Location

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