Provider Demographics
NPI:1609844307
Name:RAYBURN, STEPHANIE J (CPHT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:RAYBURN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:J
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPHT
Mailing Address - Street 1:914 SAND CUT RD
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-3813
Mailing Address - Country:US
Mailing Address - Phone:423-569-4602
Mailing Address - Fax:
Practice Address - Street 1:950 BAKER HWY
Practice Address - Street 2:SUITE #1
Practice Address - City:HUNTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37756-4168
Practice Address - Country:US
Practice Address - Phone:423-663-9355
Practice Address - Fax:423-663-3992
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18805183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician