MEDICARE: MRS. STACIE MARIE POE 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
1	183500000X	Pharmacist	013661	KY

General Provider Information

NPI Number	:	1942800677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACIE MARIE POE PHARM. D.

Provider Business Mailing Address
First Line	:	607 WINTERGREEN CT
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42104-5518
Country	:	US
Telephone Number	:	859-333-9251
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 MORGANTOWN RD
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42101-9202
Country	:	US
Telephone Number	:	270-780-9331
Fax Number	:	270-780-9934

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

Provider Enumeration Date	:	10/30/2020
Last Update Date	:	10/30/2020

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