STACEY M BANTA (NPI# 1558684852) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558684852 |
| Entity Type | Individual |
| Full Name | STACEY M BANTA |
| Practice Address |
6189 Route 31 Walgreens Pharmacy Cicero NY 13039 |
| Mailing Address |
4945 Tinderbox Cir Manlius NY 13104-2131 |
| Practice Telephone | 3156990812 |
| Practice Fax Number | 3156990818 |
| Mailing Telephone | 3156990812 |
| Mailing Fax Number | 3156990818 |
| Enumeration Date | 2010-03-02 |
| Last Update Date | 2010-03-02 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 183500000X | Pharmacist | PH21046 | MA | Pharmacy Service Providers |
| Y | 183500000X | Pharmacist | 051406 | NY | Pharmacy Service Providers |
| Street Address |
6189 ROUTE 31 WALGREENS PHARMACY |
| City | CICERO |
| State | NY |
| Zip Code | 13039 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780238212 | Cody Hodgson | Physician Assistant | 6993 Van Antwerp Drive, East, Cicero, NY 13039 | 2019-08-01 |
| 1164989810 | Emily Grace Massey | Occupational Therapy Assistant | 5962 Rte 31, Cicero, NY 13039 | 2019-02-28 |
| 1356837512 | Jennifer Lonnen Dds Pllc | Dentist | 6221 Rt 31 Ste 102, Cicero, NY 13039 | 2018-07-10 |
| 1285186916 | Bismarck Np Psychiatric Services Pllc | Nurse Practitioner | 6221 Route 31, Suite 106, Cicero, NY 13039 | 2016-10-28 |
| 1386090397 | Kristin Raineri | Dentist | 5972 Rt 31, Cicero, NY 13039 | 2016-05-09 |
| 1053788281 | Empire Vision Center, Inc | Eyewear Supplier (Equipment, not the service) | 5653 East Circle Drive, Cicero, NY 13039 | 2015-08-24 |
| 1003251018 | Christina M Smith | Licensed Practical Nurse | 8449 Bayridge Rd, Cicero, NY 13039 | 2013-05-03 |
| 1134463433 | Margaret L Southard | Case Manager/Care Coordinator | 5962 Rt 31, Suite 7 Box 10, Cicero, NY 13039 | 2012-11-27 |
| 1245589852 | Samantha Danielle Dillon | Pharmacist | 8061 Brewerton Road, Cicero, NY 13039 | 2012-08-29 |
| 1861769168 | Laura Shaw | Counselor | 6221 Rt. 31, Suite 110, Cicero, NY 13039 | 2011-11-30 |
| Find all providers in zip 13039 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942542501 | Sara Jane Micale | Pharmacist | 8702 Whiting Rd, Cicero, NY 13039-8819 | 2013-03-21 |
| 1740524834 | Travis W Boevin | Pharmacist | 8221 Hoyt Farm, Cicero, NY 13039-8931 | 2012-11-15 |
| 1245589852 | Samantha Danielle Dillon | Pharmacist | 8061 Brewerton Road, Cicero, NY 13039 | 2012-08-29 |
| 1790060507 | Charles Alan Turner | Pharmacist | 4800 W Cermak Road, Cicero, IL 60804-2531 | 2011-10-13 |
| 1336325133 | Thomas Anthony Forleo | Pharmacist | 7939 Brewerton Rd, Cicero, NY 13039-9561 | 2008-01-11 |
| 1942484456 | Emily Caitlin Foor | Pharmacist | 6189 Rt 31, Cicero, NY 13039 | 2007-12-19 |
| 1558544015 | Alan B Schwartz | Pharmacist | 8379 Thompson Rd, Cicero, NY 13039-9390 | 2007-12-07 |
| 1932232204 | Melissa M O'donnell | Pharmacist | 8061 Brewerton Rd, Cicero, NY 13039 | 2007-03-14 |
| 1881697308 | James R Capone | Pharmacist | 5701 E Circle Dr, Cicero, NY 13039-8638 | 2005-05-30 |
| 1174124069 | Demetrie Sezibera | Pharmacist | 2601 S Cicero Ave, Cicero, IL 60804-3644 | 2020-11-05 |
| Find all providers in CICERO | ||||
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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.