Individual
STACEY M THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARM D
Contact information
Practice address
200 UNIVERSITY PARK DR, CAMPUS BOX 2000, EDWARDSVILLE, IL 62026-0001
(618) 650-5131
Mailing address
200 UNIVERSITY PARK DR, CAMPUS BOX 2000, EDWARDSVILLE, IL 62026-0001
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
051292099
IL
Other
Enumeration date
08/25/2008
Last updated
08/25/2008
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