Provider Demographics
NPI:1447379201
Name:LAND, STEPHANIE (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LAND
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 1:517 BOB ODOM LOOP
Mailing Address - Street 2:
Mailing Address - City:WOODWORTH
Mailing Address - State:LA
Mailing Address - Zip Code:71485-4808
Mailing Address - Country:US
Mailing Address - Phone:318-487-0342
Mailing Address - Fax:318-448-1328
Practice Address - Street 1:517 BOB ODOM LOOP
Practice Address - Street 2:
Practice Address - City:WOODWORTH
Practice Address - State:LA
Practice Address - Zip Code:71485-4808
Practice Address - Country:US
Practice Address - Phone:318-487-0342
Practice Address - Fax:318-448-1328
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist