=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730025909
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STACI MAE PEOPLES CPHT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2026
-----------------------------------------------------
Last Update Date | 04/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 108 3RD AVE
-----------------------------------------------------
City | SOUTH CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25303-1434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-719-5761
-----------------------------------------------------
Fax | 304-388-8626
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 3RD AVE
-----------------------------------------------------
City | SOUTH CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25303-1434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-719-5761
-----------------------------------------------------
Fax | 304-388-8626
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | PT0008833
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------