Organization
STACYS WELLNESS PHARMACY INC
Active
Other names
Stacy's Wellness Pharmacy, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
STACY HAZELWOOD (OWNER/PRESIDENT/PIC/AO)
(931) 474-0600
Entity
Organization
Contact information
Practice address
485 N CHANCERY ST STE 1, MCMINNVILLE, TN 37110-8903
(931) 474-0600
(931) 474-0601
Mailing address
485 N CHANCERY ST STE 1, MCMINNVILLE, TN 37110-8903
(931) 474-0600
(931) 474-0601
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5899
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2166501
PK
—
05
—
Q033117
—
TN
Enumeration date
11/21/2016
Last updated
07/19/2018
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