Individual
STACIE ELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
1309 NW 12TH AVE, AVA, MO 65608
(417) 683-4708
Mailing address
507 PRIMROSE LN, HOUSTON, MO 65483-2106
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2000166259
MO
Other
Enumeration date
11/05/2020
Last updated
04/05/2022
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