MEDICARE: KIERSTEN ANNE STAILEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26031409A	IN

General Provider Information

NPI Number	:	1073450383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIERSTEN ANNE STAILEY

Provider Business Mailing Address
First Line	:	789 STATE ROAD, IN-39 BYPASS
Second Line	:
City	:	MARTINSVILLE
State	:	IN
Zip	:	46151
Country	:	US
Telephone Number	:	765-342-2121
Fax Number	:

Provider Business Practice Location Address
First Line	:	789 STATE ROAD, IN-39 BYPASS
Second Line	:
City	:	MARTINSVILLE
State	:	IN
Zip	:	46151
Country	:	US
Telephone Number	:	765-342-2121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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Directions to “ KIERSTEN ANNE STAILEY ” Practice Location

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