Provider Demographics
NPI:1720358146
Name:STIMAC, MAGDALENE MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:MAGDALENE
Middle Name:MARIE
Last Name:STIMAC
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 1:38731 EDWARD WALSH DR
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-8833
Mailing Address - Country:US
Mailing Address - Phone:440-413-0529
Mailing Address - Fax:
Practice Address - Street 1:9400 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4520
Practice Address - Country:US
Practice Address - Phone:440-255-6247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03226210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist