Healthcare Provider Details

I. General information

NPI: 1538636170
Provider Name (Legal Business Name): STACEY PASCOE PHARMD, BCPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 HIGHLAND BLVD
BOZEMAN MT
59715-6900
US

IV. Provider business mailing address

925 HIGHLAND BLVD
BOZEMAN MT
59715-6900
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-1623
  • Fax:
Mailing address:
  • Phone: 406-414-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number18314
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number18314
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: