Healthcare Provider Details

I. General information

NPI: 1518893494
Provider Name (Legal Business Name): DAVID STACEY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1666 SW 16TH ST
GAINESVILLE FL
32608-1161
US

IV. Provider business mailing address

1666 SW 16TH ST
GAINESVILLE FL
32608-1161
US

V. Phone/Fax

Practice location:
  • Phone: 386-216-8226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License NumberPS24431
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: