Provider Demographics
NPI:1902105885
Name:SHAMBURGER-SMITH, STACY MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MARIE
Last Name:SHAMBURGER-SMITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2479 BROOK PARK TRL
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5511
Mailing Address - Country:US
Mailing Address - Phone:770-265-8280
Mailing Address - Fax:
Practice Address - Street 1:1545 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-4604
Practice Address - Country:US
Practice Address - Phone:770-338-2006
Practice Address - Fax:770-277-0385
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist