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General NPI Number Information
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NPI Number | 1336881002
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Entity Type | Individual
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Provider Name | STACI ANDERSON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 310 W 5TH ST
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City | BENTON
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State | KY
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Zip | 42025-1102
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Country | US
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Telephone | 270-527-3597
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Fax |
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Provider Business Mailing Address
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Address Line | 161 HUNTERS RDG
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City | PADUCAH
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State | KY
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Zip | 42001-8132
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Country | US
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Telephone | 770-597-8445
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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 | 015563
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License Number State | KY
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