Provider Demographics
NPI:1447854435
Name:PRESBYLA, STACI ANN
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:ANN
Last Name:PRESBYLA
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 1:625 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3449
Mailing Address - Country:US
Mailing Address - Phone:813-232-2925
Mailing Address - Fax:813-232-2976
Practice Address - Street 1:625 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3449
Practice Address - Country:US
Practice Address - Phone:813-232-2925
Practice Address - Fax:813-232-2976
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist