Provider Demographics
NPI:1053084582
Name:STUMPHAUZER, RACHEL ANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANNE
Last Name:STUMPHAUZER
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 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-5500
Mailing Address - Fax:208-625-5501
Practice Address - Street 1:1919 LINCOLN WAY STE 211
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2527
Practice Address - Country:US
Practice Address - Phone:208-625-5500
Practice Address - Fax:208-625-5501
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190259331835P2201X
IDP95531835P2201X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care