Provider Demographics
NPI:1326164880
Name:STEFANSKI, GRETCHEN MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:MARIE
Last Name:STEFANSKI
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 1:397 HYANNIS HILLS DR
Mailing Address - Street 2:
Mailing Address - City:TEKONSHA
Mailing Address - State:MI
Mailing Address - Zip Code:49092-9276
Mailing Address - Country:US
Mailing Address - Phone:517-767-4280
Mailing Address - Fax:517-767-4603
Practice Address - Street 1:129 NORTH MAIN STREET BOX 217
Practice Address - Street 2:
Practice Address - City:TEKONSHA
Practice Address - State:MI
Practice Address - Zip Code:49092-0217
Practice Address - Country:US
Practice Address - Phone:517-767-3474
Practice Address - Fax:517-767-4603
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist