Provider Demographics
NPI:1497350482
Name:EBLING-STOUT, ALEXIS (RPH)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:EBLING-STOUT
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 1:14 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-9215
Mailing Address - Country:US
Mailing Address - Phone:717-644-3362
Mailing Address - Fax:
Practice Address - Street 1:1200 MARKET ST
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1417
Practice Address - Country:US
Practice Address - Phone:717-761-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist