Stacey Holderread, RPH
Individual provider Active NPI Pharmacist · North Liberty, IN
NPI 1497038962 · NPPES record last updated Sep 21, 2011
Key facts
- NPI
- 1497038962
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 26018667A (IN)
- Practice address
- 104 Singleton Dr
North Liberty, IN 46554-9051 - Phone
- (574) 656-3218
- NPI assigned
- Sep 21, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26018667A | IN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26018667A | IN | Yes |
Addresses
Primary practice location
104 Singleton Dr
North Liberty, IN 46554-9051
Mailing address
104 Singleton Dr
North Liberty, IN 46554-9051
Phone (574) 656-3218
Other providers in North Liberty, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.