Provider Demographics
NPI:1356637771
Name:KRUEGER, STEPHANIE ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:KRUEGER
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 1:4841 GROVE BARTON RD
Mailing Address - Street 2:T-1080
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1900
Mailing Address - Country:US
Mailing Address - Phone:919-785-0335
Mailing Address - Fax:919-785-0335
Practice Address - Street 1:4841 GROVE BARTON RD
Practice Address - Street 2:T-1080
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1900
Practice Address - Country:US
Practice Address - Phone:919-785-0335
Practice Address - Fax:919-785-0335
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist