Provider Demographics
NPI:1457627713
Name:STIMETZ, MADELYN (RPH)
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:STIMETZ
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 1:35836 SMITHFIELD CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3140
Mailing Address - Country:US
Mailing Address - Phone:248-474-1912
Mailing Address - Fax:
Practice Address - Street 1:31411 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5264
Practice Address - Country:US
Practice Address - Phone:734-326-2990
Practice Address - Fax:734-728-4196
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist