Provider Demographics
NPI:1447648514
Name:LENZ, STACEY
Entity type:Individual
Prefix:MISS
First Name:STACEY
Middle Name:
Last Name:LENZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 STAFFORD PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2734
Mailing Address - Country:US
Mailing Address - Phone:609-978-4923
Mailing Address - Fax:609-978-5854
Practice Address - Street 1:209 STAFFORD PARK BLVD
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2734
Practice Address - Country:US
Practice Address - Phone:609-978-4923
Practice Address - Fax:609-978-5854
Is Sole Proprietor?:No
Enumeration Date:2014-12-24
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RW01664800183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician