Individual provider · Type 1 NPI
Stacey M. Thacker, PHARM D
Primary Care Clinic/Center · Edwardsville, IL
NPI number
1962659664
Active
Practice location
200 University Park Dr, Campus Box 2000
Edwardsville, IL 62026-0001
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Primary Care Clinic/Center Primary | 261QP2300X | 051292099 (IL) |
Primary Care Clinic/Center: Definition to come...
About NPI 1962659664
Stacey M. Thacker, PHARM D's National Provider Identifier is 1962659664, issued on Aug 25, 2008. The primary taxonomy on file is Primary Care Clinic/Center (261QP2300X), and the practice location is in Edwardsville, IL. The record was last updated on Aug 25, 2008.