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General NPI Number Information
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NPI Number | 1306272679
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Entity Type | Individual
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Provider Name | STACEY DUST PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/18/2013
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 7500 PRESTON RD
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City | FRISCO
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State | TX
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Zip | 75034-5615
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Country | US
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Telephone | 972-377-0840
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Fax |
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Provider Business Mailing Address
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Address Line | 8511 SANTA CLARA DR
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City | FRISCO
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State | TX
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Zip | 75033-3028
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Country | US
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Telephone | 217-565-3636
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 53969
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 53969
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License Number State | TX
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