Provider Demographics
NPI:1861915100
Name:STACY, GLORIA FRANKENFELD
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:FRANKENFELD
Last Name:STACY
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 1:540 W JAMESTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-3464
Mailing Address - Country:US
Mailing Address - Phone:419-934-3023
Mailing Address - Fax:
Practice Address - Street 1:540 W. JAMESTOWN AVENUE
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-4488
Practice Address - Country:US
Practice Address - Phone:419-934-3023
Practice Address - Fax:419-934-3023
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH031149951835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist