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NPI Code Detail

MEDICARE: ERIC STACKLEY PHARM.D

MEDICARE:   ERIC  STACKLEY  PHARM.D
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
1183500000XPharmacist24522NC

General Provider Information

NPI Number : 1366844292
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC STACKLEY PHARM.D
Provider Business Mailing Address
First Line : 610 N MAIN ST
Second Line :
City : WALNUT COVE
State : NC
Zip : 27052-9248
Country : US
Telephone Number : 336-591-4351
Fax Number :
Provider Business Practice Location Address
First Line : 610 N MAIN ST
Second Line :
City : WALNUT COVE
State : NC
Zip : 27052-9248
Country : US
Telephone Number : 336-591-4351
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2014
Last Update Date : 09/26/2014

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Directions to “ ERIC STACKLEY PHARM.D” Practice Location

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