Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
STACEY M THACKER, PHARM D
Active Sole ProprietorSTACEY M THACKER, PHARM D is a Primary Care Clinic healthcare provider located in EDWARDSVILLE, Illinois. NPI 1962659664 is currently active in the NPPES registry. Verify at CMS.
Primary Care Clinic · EDWARDSVILLE, IL
Registration Details
- NPI Number
- 1962659664
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Aug 25, 2008 (17.990959316108 yrs)
- Last Updated
- Aug 25, 2008
- License
-
051292099 (IL)
- Sole Proprietor
- Yes
Practice Information
- Address
-
200 UNIVERSITY PARK DRCAMPUS BOX 2000EDWARDSVILLE, IL, 620260001Browse IL providers · Browse ZIP 62026
- Phone
- 6186505131
- Primary Specialty
-
Primary Care Clinic
261QP2300X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.