Provider Demographics
NPI:1164714622
Name:NAMETH, STEPHANIE MARIE (STEPHANIE NAMETH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:NAMETH
Suffix:
Gender:F
Credentials:STEPHANIE NAMETH
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:NAMETH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:STEPHANIE NAMETH
Mailing Address - Street 1:9548 GRAYSTONE LN
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4538
Mailing Address - Country:US
Mailing Address - Phone:440-479-6609
Mailing Address - Fax:
Practice Address - Street 1:25221 MILES RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5474
Practice Address - Country:US
Practice Address - Phone:440-479-6609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230719183500000X
TN34442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist