Provider Demographics
NPI:1629681309
Name:IBEY, STEPHANIE
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:IBEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05061-4452
Mailing Address - Country:US
Mailing Address - Phone:802-661-8523
Mailing Address - Fax:
Practice Address - Street 1:800 US ROUTE 302
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-2382
Practice Address - Country:US
Practice Address - Phone:802-476-6659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0003836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist