Provider Demographics
NPI:1861405094
Name:CALDWELL, STACY LYNN (RPH)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 BOHEMIAN HWY
Mailing Address - Street 2:
Mailing Address - City:OWENSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65066-3026
Mailing Address - Country:US
Mailing Address - Phone:573-437-5966
Mailing Address - Fax:
Practice Address - Street 1:601 EAST HWY 28
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65066
Practice Address - Country:US
Practice Address - Phone:573-437-3440
Practice Address - Fax:573-437-4963
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist