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General NPI Number Information
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NPI Number | 1619254828
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Entity Type | Individual
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Provider Name | MRS. STACY J WACHTER
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Gender | Female
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 1260 WASHINGTON ST
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City | BLAIR
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State | NE
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Zip | 68008-1732
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Country | US
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Telephone | 402-533-8444
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Fax | 402-533-8480
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Provider Business Mailing Address
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Address Line | 14551 COUNTY ROAD 23
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City | BLAIR
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State | NE
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Zip | 68008-5573
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Country | US
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Telephone | 402-533-4514
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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 | 10841
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License Number State | NE
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