Basic Information
| Provider Information | |||||||||
| NPI: | 1700168259 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARDEO | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | MCDONOUGH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARMD, BCPS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MADISON AVE | ||||||||
| Address2: | BOX 80 | ||||||||
| City: | MORRISTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079606136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739715000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 MADISON AVE | ||||||||
| Address2: | BOX 80 | ||||||||
| City: | MORRISTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079606136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739715000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2011 | ||||||||
| LastUpdateDate: | 09/11/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | 28RI02928800 | NJ | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.