Provider Demographics
NPI:1548660269
Name:CARR, STACY ANN
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:ANN
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 ARSDALE RD
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7151
Mailing Address - Country:US
Mailing Address - Phone:928-814-9138
Mailing Address - Fax:
Practice Address - Street 1:2520 CUTHBERTSON RD
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7441
Practice Address - Country:US
Practice Address - Phone:928-814-9138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27657183500000X
AZS012730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist