Provider Demographics
NPI:1407298219
Name:BAER, STEPHANIE ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANN
Last Name:BAER
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 1:9885 WICKER AVE
Mailing Address - Street 2:T-2095
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9413
Mailing Address - Country:US
Mailing Address - Phone:219-365-8619
Mailing Address - Fax:219-365-8609
Practice Address - Street 1:9885 WICKER AVE
Practice Address - Street 2:T-2095
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9413
Practice Address - Country:US
Practice Address - Phone:219-365-8619
Practice Address - Fax:219-365-8609
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024494A183500000X
IL051.296602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist