Provider Demographics
NPI:1609993070
Name:MAIN, STEPHANIE (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MAIN
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 1:5750 MERLE HAY RD # 9
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1215
Mailing Address - Country:US
Mailing Address - Phone:515-270-9212
Mailing Address - Fax:
Practice Address - Street 1:5750 MERLE HAY RD # 9
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1215
Practice Address - Country:US
Practice Address - Phone:515-270-9212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist