Provider Demographics
NPI:1326333741
Name:TAPP, STEPHANIE KENNEDY
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KENNEDY
Last Name:TAPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27100 WIXOM RD
Mailing Address - Street 2:T-1465
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1115
Mailing Address - Country:US
Mailing Address - Phone:248-374-0892
Mailing Address - Fax:
Practice Address - Street 1:27100 WIXOM RD
Practice Address - Street 2:T-1465
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1115
Practice Address - Country:US
Practice Address - Phone:248-374-0892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist