Healthcare Provider Details

I. General information

NPI: 1114831591
Provider Name (Legal Business Name): STACEY LYNN JONES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 W BADDOUR PKWY
LEBANON TN
37087-2513
US

IV. Provider business mailing address

200 TRADITIONS WAY APT 415
LEBANON TN
37087-5050
US

V. Phone/Fax

Practice location:
  • Phone: 615-443-6013
  • Fax:
Mailing address:
  • Phone: 217-433-4447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48532
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: