Provider Demographics
NPI:1356599021
Name:JOHNSON, STACY GEISLER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:GEISLER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:GEISLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5600 OAKBROOK PKWY
Mailing Address - Street 2:NORCROSS
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1873
Mailing Address - Country:US
Mailing Address - Phone:678-987-0321
Mailing Address - Fax:
Practice Address - Street 1:5600 OAKBROOK PKWY
Practice Address - Street 2:NORCROSS
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1873
Practice Address - Country:US
Practice Address - Phone:678-987-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020849183500000X, 1835P0018X
NC15938183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist