Provider Demographics
NPI:1720398795
Name:DEMMER, STEPHANIE LYN (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYN
Last Name:DEMMER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 W 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-4258
Mailing Address - Country:US
Mailing Address - Phone:509-308-8339
Mailing Address - Fax:
Practice Address - Street 1:1321 N COLUMBIA CENTER BLVD
Practice Address - Street 2:SUITE 845
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7689
Practice Address - Country:US
Practice Address - Phone:509-783-3413
Practice Address - Fax:509-735-2803
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60153886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist