Provider Demographics
NPI:1053649111
Name:DANG, STEPHANIE (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:DANG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12225 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-8805
Mailing Address - Country:US
Mailing Address - Phone:281-431-4248
Mailing Address - Fax:281-431-4056
Practice Address - Street 1:12225 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-8805
Practice Address - Country:US
Practice Address - Phone:281-431-4248
Practice Address - Fax:281-431-4056
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist