Provider Demographics
NPI:1548859051
Name:BLANKENSHIP, STACEY METHENY (PHARMD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:METHENY
Last Name:BLANKENSHIP
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 1:14418 OVERLOOK RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERDAM
Mailing Address - State:VA
Mailing Address - Zip Code:23015-1787
Mailing Address - Country:US
Mailing Address - Phone:804-883-7969
Mailing Address - Fax:
Practice Address - Street 1:4060 INNSLAKE DR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3342
Practice Address - Country:US
Practice Address - Phone:804-346-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist