Provider Demographics
NPI:1164417762
Name:SPONENBERG, STEPHANIE PARKER (RPH)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:PARKER
Last Name:SPONENBERG
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 1:7165 CHAPINS RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8754
Mailing Address - Country:US
Mailing Address - Phone:570-752-5458
Mailing Address - Fax:
Practice Address - Street 1:538 S STATE ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:PA
Practice Address - Zip Code:17846-9219
Practice Address - Country:US
Practice Address - Phone:570-458-5573
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042476L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist