Healthcare Provider Details

I. General information

NPI: 1508199704
Provider Name (Legal Business Name): STACY LYNN GOULD PHARMD, BCPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 07/21/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY DRIVE C
PITTSBURGH PA
15240
US

IV. Provider business mailing address

469 KAMARI CV
NAPLES FL
34114-8347
US

V. Phone/Fax

Practice location:
  • Phone: 412-822-2222
  • Fax:
Mailing address:
  • Phone: 304-517-0164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number03441675
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: