Individual
DR. STACI MARIE THAYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
306 BLUE LAKES BLVD N, TWIN FALLS, ID 83301-4827
(208) 734-4053
(208) 734-4295
Mailing address
5125 BROOKSTONE ST, CHUBBUCK, ID 83202-5247
(208) 431-7006
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P8470
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
ID
Enumeration date
11/17/2019
Last updated
11/17/2019
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