Provider Demographics
NPI:1649800921
Name:BURTON, STACIA (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 HARTLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1558
Mailing Address - Country:US
Mailing Address - Phone:859-245-5855
Mailing Address - Fax:859-272-5539
Practice Address - Street 1:4750 HARTLAND PKWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-1558
Practice Address - Country:US
Practice Address - Phone:859-245-5855
Practice Address - Fax:859-272-5539
Is Sole Proprietor?:No
Enumeration Date:2020-01-25
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist