Provider Demographics
NPI:1417576158
Name:STUERMAN, MARDELL GLADYS (RPH)
Entity Type:Individual
Prefix:
First Name:MARDELL
Middle Name:GLADYS
Last Name:STUERMAN
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 1:2827 HAMILTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-2494
Mailing Address - Country:US
Mailing Address - Phone:712-277-8734
Mailing Address - Fax:712-277-2329
Practice Address - Street 1:2827 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-2494
Practice Address - Country:US
Practice Address - Phone:712-277-8734
Practice Address - Fax:712-277-2329
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist