Provider Demographics
NPI:1548834393
Name:DENNIS, STACY ANN (CHPT)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:ANN
Last Name:DENNIS
Suffix:
Gender:F
Credentials:CHPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 WILLOW STREET PIKE N
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584-9388
Mailing Address - Country:US
Mailing Address - Phone:717-464-1720
Mailing Address - Fax:717-464-1732
Practice Address - Street 1:2600 WILLOW STREET PIKE N
Practice Address - Street 2:
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584-9388
Practice Address - Country:US
Practice Address - Phone:717-464-1720
Practice Address - Fax:717-464-1732
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2801-0010-4030-192183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician