Provider Demographics
NPI:1659982379
Name:FRAIRE, STEPHANIE ANAIS
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANAIS
Last Name:FRAIRE
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 1:1801 GALLATIN PIKE N
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2016
Mailing Address - Country:US
Mailing Address - Phone:615-860-2272
Mailing Address - Fax:615-860-1093
Practice Address - Street 1:1801 GALLATIN PIKE N
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2016
Practice Address - Country:US
Practice Address - Phone:615-860-2272
Practice Address - Fax:615-860-1093
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000042781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist