Provider Demographics
NPI:1639398860
Name:RIDDLE, STEPHANIE M (PHARMD CPP)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:M
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:PHARMD CPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 FOXVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27313-9572
Mailing Address - Country:US
Mailing Address - Phone:336-676-8856
Mailing Address - Fax:
Practice Address - Street 1:3511 W MARKET ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-4443
Practice Address - Country:US
Practice Address - Phone:336-632-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7000081835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC700008OtherCLINICAL PHARMACIST PRACT
NCMM1023326OtherDEA #