DR. STACY ALLEN MANGUM (NPI# 1619968237) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619968237 |
| Entity Type | Individual |
| Full Name | DR. STACY ALLEN MANGUM |
| Credential | PHARM.D. |
| Practice Address |
1200 N One Mile Rd Missouri Southern Healthcare Dexter MO 63841-1000 |
| Mailing Address |
704 Chautauqua Ln Dexter MO 63841-1929 |
| Practice Telephone | 5736141957 |
| Practice Fax Number | 5736246265 |
| Mailing Telephone | 5736249657 |
| Mailing Fax Number | 5736246265 |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1835P1200X |
Pharmacist Specialization: Pharmacotherapy |
044733 | MO | Pharmacy Service Providers |
| Street Address |
1200 N ONE MILE RD MISSOURI SOUTHERN HEALTHCARE |
| City | DEXTER |
| State | MO |
| Zip Code | 63841-1000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578557872 | Mina K Massey | Family Medicine | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2005-09-01 |
| 1255801247 | Kristin Suzanne Wheeler Guethle | Nurse Practitioner | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2018-12-03 |
| 1013493865 | Kerri Crawley | Nurse Practitioner | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2018-07-16 |
| 1578080214 | Stoddard Emergency Group, LLC | Physician Assistant | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2017-08-24 |
| 1851765614 | Leah Legrand | Nurse Practitioner | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2015-11-17 |
| 1841685989 | Angela Weiss | Nurse Practitioner | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2015-04-06 |
| 1356762132 | Meramec Emergency Physicians, LLP | Hospitalist | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2013-12-23 |
| 1407100944 | Tory L Sherman | Physician Assistant | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2012-11-06 |
| 1386802023 | Southeast Health Center of Stoddard County, LLC | Medicare Defined Swing Bed Unit | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2008-05-29 |
| 1396945663 | Cory W Blocker | Nurse Practitioner | 1200 N One Mile Rd, Dexter, MO 63841-1000 | 2007-07-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417558941 | Christa Renee Mcbroom | Pharmacist | 2025 Business Hwy 60w, Dexter, MO 63841 | 2020-11-02 |
| 1306230107 | David Mulcahy | Pharmacist | 904 West Business Hwy 60, Dexter, MO 63841 | 2015-03-19 |
| 1285038935 | Clearwater In-home Care, Inc. | Technician | 1525 Business Highway 60, Suite C, Dexter, MO 63841 | 2014-10-09 |
| 1720404064 | William Simmons | Pharmacist | 904 W Business Highway 60, Dexter, MO 63841 | 2014-03-11 |
| 1134498736 | Susan Caroline Jones | Physical Therapist | 913 West Business Hwy 60, Dexter, MO 63841 | 2011-12-28 |
| 1427350594 | Dexter Hospital LLC | Family Medicine | 2025 W Bus Hwy 60, Dexter, MO 63841 | 2010-11-23 |
| 1992028112 | Hilda Fuwell's Residential Care LLC | Clinic/Center | 900 South One Mile Road, Dexter, MO 63841 | 2010-03-02 |
| 1508197047 | Super D Drugs Acquisition Co | Durable Medical Equipment & Medical Supplies | 907 West Business Hwy. 60, Dexter, MO 63841 | 2010-01-22 |
| 1215262183 | Ozark Wellness & Athletic Club | Physical Therapist | 1521 W Bus. Hwy. 60, Dexter, MO 63841 | 2009-10-12 |
| 1225268618 | Practice Tee, LLC | Family Medicine | 1523 W Business Hwy 60, Dexter, MO 63841 | 2009-07-20 |
| Find all providers in zip 63841 | ||||
| Taxonomy Code | 1835P1200X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Pharmacotherapy |
| A licensed pharmacist who has demonstrated specialized knowledge and skill in optimizing pharmacotherapeutic care of patients, by developing, implementing, monitoring, and modifying complex treatment plans, providing advanced level education and consultation, and collaborating with other health professionals in the management of therapy. |
| Notes: Source: Specialty certification and recertification program administered by Board of Pharmaceutical Specialties, www.bpsweb.org [7/1/2006: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881226298 | Christina L Stafford | Pharmacist | 1306 W Business Loop 70, Columbia, MO 65202-1325 | 2020-02-04 |
| 1659802452 | Joshua Shipley | Pharmacist | 809 Peruque View Ct, Wentzville, MO 63385-4340 | 2017-03-23 |
| 1811361454 | James Preston Jr. | Pharmacist | 915 N. Grand Vlvd, Pharmacy Dept., John Cochran Va Medical Center, Saint Louis, MO 63106 | 2015-11-19 |
| 1619375896 | Diane Klueppel | Pharmacist | 4325 Ventura Place Dr, Saint Louis, MO 63128-3159 | 2014-12-20 |
| 1245592054 | Stanley Charles Johnston | Pharmacist | 105 W. Eldon St, St. James, MO 65559 | 2012-06-08 |
| 1609150564 | Steve C Platou | Pharmacist | 2159 S. Campbell Ave, Springfield, MO 65807 | 2011-10-10 |
| 1295018422 | Gregory James Serocki | Pharmacist | 3189 S Woodstock Ave, Springfield, MO 65809-4146 | 2011-09-23 |
| 1760771943 | Scott Andrew Coon | Pharmacist | 4588 Parkview Place, Arb 440, Saint Louis, MO 63110-1088 | 2011-03-28 |
| 1508194556 | Kailye Kelly Hsia | Pharmacist | 1555 Mckelvey Rd, Maryland Heights, MO 63043-2852 | 2009-12-03 |
| 1013244284 | Stephanie R Pieszchalski | Pharmacist | 14528 S Outer 40 Rd, Suite 300, Chesterfield, MO 63017-5785 | 2009-11-10 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.