Individual
DR. STACY ALLEN MANGUM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
1200 N ONE MILE RD, MISSOURI SOUTHERN HEALTHCARE, DEXTER, MO 63841-1000
(573) 614-1957
(573) 624-6265
Mailing address
704 CHAUTAUQUA LN, DEXTER, MO 63841-1929
(573) 624-9657
(573) 624-6265
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
044733
MO
Other
Enumeration date
11/02/2005
Last updated
07/08/2007
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