1871956946 NPI number — MRS. STACEY MICHELLE PUCCI PHARMD

Table of content: MRS. STACEY MICHELLE PUCCI PHARMD (NPI 1871956946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871956946 NPI number — MRS. STACEY MICHELLE PUCCI PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUCCI
Provider First Name:
STACEY
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GORDON
Provider Other First Name:
STACEY
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871956946
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8825 BEE CAVES RD
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78746-4720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-382-9381
Provider Business Mailing Address Fax Number:
512-532-6689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8825 BEE CAVES RD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746-4720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-382-9381
Provider Business Practice Location Address Fax Number:
512-532-6689
Provider Enumeration Date:
04/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  51698 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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