Healthcare Provider Details

I. General information

NPI: 1154922482
Provider Name (Legal Business Name): STACY NORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 TOWN CENTER DR
BOWLING GREEN MO
63334-2801
US

IV. Provider business mailing address

20 LAKE FOREST CT
TROY MO
63379-3861
US

V. Phone/Fax

Practice location:
  • Phone: 573-324-0004
  • Fax:
Mailing address:
  • Phone: 636-697-2217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2012027492
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: