Provider Demographics
NPI:1598360190
Name:DOUMA, STEPHANIE MEREDITH (PHARM D)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MEREDITH
Last Name:DOUMA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 AFFECTION RD
Mailing Address - Street 2:
Mailing Address - City:DAUPHIN
Mailing Address - State:PA
Mailing Address - Zip Code:17018-9642
Mailing Address - Country:US
Mailing Address - Phone:717-599-9104
Mailing Address - Fax:
Practice Address - Street 1:1575 S MARKET ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2880
Practice Address - Country:US
Practice Address - Phone:717-367-2173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP449277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty