Provider Demographics
NPI:1376184846
Name:MAURENT, STEPHANIE WYNNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:WYNNE
Last Name:MAURENT
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 1:1170 E GENTILE ST
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-6802
Mailing Address - Country:US
Mailing Address - Phone:801-546-3497
Mailing Address - Fax:801-544-1440
Practice Address - Street 1:1170 E GENTILE ST
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-6802
Practice Address - Country:US
Practice Address - Phone:801-546-3497
Practice Address - Fax:801-544-1440
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5247165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist