MEDICARE: STACIE LYNN MOCK PHARMD

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	19704	NC

General Provider Information

NPI Number	:	1851520597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACIE LYNN MOCK PHARMD

Provider Business Mailing Address
First Line	:	2611 GARDEN HILL DR.
Second Line	:	APT 207
City	:	RALEIGH
State	:	NC
Zip	:	27614
Country	:	US
Telephone Number	:	910-465-0926
Fax Number	:

Provider Business Practice Location Address
First Line	:	8385 CREEDMOOR ROAD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612
Country	:	US
Telephone Number	:	919-847-8101
Fax Number	:

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

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	07/02/2009

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