Healthcare Provider Details

I. General information

NPI: 1568281509
Provider Name (Legal Business Name): STACEY THOMAS-GOOCH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 N MILITARY HWY
NORFOLK VA
23502-2425
US

IV. Provider business mailing address

1170 N MILITARY HWY
NORFOLK VA
23502-2425
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-6330
  • Fax:
Mailing address:
  • Phone: 757-461-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2761870
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202223580
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: