Provider Demographics
NPI:1609688803
Name:LOONEY, STACEY NICOLE (PHARMD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:NICOLE
Last Name:LOONEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1368 STRIP BENCH RD
Mailing Address - Street 2:
Mailing Address - City:VANSANT
Mailing Address - State:VA
Mailing Address - Zip Code:24656-8549
Mailing Address - Country:US
Mailing Address - Phone:276-312-4718
Mailing Address - Fax:
Practice Address - Street 1:4488 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0722
Practice Address - Country:US
Practice Address - Phone:540-989-4448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202222456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist