Shacresa D Staley, PHARM.D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

RPH023682 Issued in GA

Practice address

2990 Five Forks Trickum Rd
Lawrenceville, GA 30044-5872

Phone

(770) 978-6475

Fax

(770) 978-0369

NPI assigned

Sep 19, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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.

• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

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

{
    "created_epoch": "1316390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671667200000",
    "number": "1255613907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 AMALFI WAY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300447857",
            "telephone_number": "901-246-9033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2990 FIVE FORKS TRICKUM RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300445872",
            "telephone_number": "770-978-6475",
            "fax_number": "770-978-0369"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4235 Lawrenceville Hwy NW",
            "address_purpose": "LOCATION",
            "city": "Lilburn",
            "state": "GA",
            "postal_code": "300473427",
            "country_code": "US",
            "telephone_number": "770-921-7074",
            "fax_number": "770-921-7083",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STALEY",
        "first_name": "SHACRESA",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-19",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH023682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "RXM.05446@STORE.WALGREENS.COM",
            "affiliation": "Y",
            "affiliationName": "Walgreens",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2990 Five Forks Trickum Rd",
            "city": "Lawrenceville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300445872",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• St Margaret'S Home Care
• St. Mary'S Independent Living Extensions
• Rhonda St. Phard
• Stable Care Services, Inc
• Jon E Stahlman, MD
• Ioan Marius Stalinescu, PTA
• Courtney Stallworth, BSN RN IBCLC
• Devona M. Stalnaker-Shofner, LPC
• Anne Stambaugh, RN
• Jordan Mackenzie Stamper, NP

• Pharmacist in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Pharmacist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; 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.