Healthcare Provider Details

I. General information

NPI: 1144383977
Provider Name (Legal Business Name): STACY R B HOFFMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY R BOLTZ PHARMD

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 LLEWELLYN AVE
FORT GEORGE G MEADE MD
20755-5800
US

IV. Provider business mailing address

1935 ARTILLERY LN
ODENTON MD
21113-2658
US

V. Phone/Fax

Practice location:
  • Phone: 301-677-8611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17094
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: