Healthcare Provider Details

I. General information

NPI: 1609320738
Provider Name (Legal Business Name): STACIE BROOKE DAVIS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACIE DAVIS TURBERVILLE PHARMD

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S JACKSON ST
GROVE HILL AL
36451-3007
US

IV. Provider business mailing address

PO BOX 790
GROVE HILL AL
36451-0790
US

V. Phone/Fax

Practice location:
  • Phone: 251-275-3669
  • Fax: 251-275-8190
Mailing address:
  • Phone: 251-275-3669
  • Fax: 251-275-8190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17836
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: