Provider Demographics
NPI:1871956946
Name:PUCCI, STACEY MICHELLE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:MICHELLE
Last Name:PUCCI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:MICHELLE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8825 BEE CAVES RD
Mailing Address - Street 2:STE A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4720
Mailing Address - Country:US
Mailing Address - Phone:512-382-9381
Mailing Address - Fax:512-532-6689
Practice Address - Street 1:8825 BEE CAVES RD
Practice Address - Street 2:STE A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-4720
Practice Address - Country:US
Practice Address - Phone:512-382-9381
Practice Address - Fax:512-532-6689
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist