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General NPI Number Information
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NPI Number | 1740882414
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Entity Type | Individual
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Provider Name | STACY MELODY FOLSOM PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | 641 VETERANS PKWY S
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City | MOULTRIE
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State | GA
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Zip | 31788-8843
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Country | US
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Telephone | 229-985-6850
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Fax | 229-985-9421
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Provider Business Mailing Address
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Address Line | 3559 ANTIOCH GREGGS RD
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City | ADEL
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State | GA
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Zip | 31620-9647
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Country | US
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Telephone | 229-891-8985
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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 | RPH020044
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License Number State | GA
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