Stacey Lynn McDonald, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

16488-40 Issued in WI

Practice address

1561 W Mason St
Green Bay, WI 54303-2215

Phone

(920) 497-5959

NPI assigned

Apr 26, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wisconsin CVS Pharmacy LLC

  • Pharmacy
  • Green Bay, WI
  • NPI 1447291315
  NPD (past)
• Wisconsin CVS Pharmacy LLC

  • Pharmacy
  • Glendale, WI
  • NPI 1649947573
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587859200000",
    "number": "1225658636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3480 WHITE DOVE LN",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541156860",
            "telephone_number": "262-490-3684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1561 W MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032215",
            "telephone_number": "920-497-5959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "STACEY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-26",
        "last_updated": "2020-04-26",
        "certification_date": "2020-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CO",
            "license": "PHA.0019174",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "16488-40",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy Boone McCue, MD
• Dawn P McCullough, APNP
• Nichole McDermid, ABO
• Kerri Marie McDermott, BS
• Jessica R McDonald, APNP
• Faye McDonough
• Patrick Michael McDonough, MD
• Kathleen Ann McDougal, MD
• Elise McGhee
• Rachel Ann McGill, NP

• Pharmacist in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Pharmacist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.