Provider Demographics
NPI:1326378183
Name:ROOT, STEPHANIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ROOT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W CLAIREMONT AVE
Mailing Address - Street 2:INPATIENT PHARMACY DEPARTMENT
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6122
Mailing Address - Country:US
Mailing Address - Phone:715-717-1000
Mailing Address - Fax:
Practice Address - Street 1:900 W CLAIREMONT AVE
Practice Address - Street 2:INPATIENT PHARMACY DEPARTMENT
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6122
Practice Address - Country:US
Practice Address - Phone:715-717-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2011-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16129-040183500000X
MN119756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist