| NPI | 1093797490 |
|---|---|
| Former Name | STACEY SUE CARPENTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-2-26356) |
| Additional Taxonomies | 1835P1300X Pharmacist, Psychiatric (Licence: OH 03-2-26356) |
| Enumeration Date | 2005-11-19 |
| Last Update Date | 2010-08-18 |