Provider Demographics
NPI:1750666160
Name:ANDERSON, STEPHANIE FLYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:FLYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-6501
Mailing Address - Country:US
Mailing Address - Phone:508-477-0137
Mailing Address - Fax:508-477-0361
Practice Address - Street 1:21 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-6501
Practice Address - Country:US
Practice Address - Phone:508-477-0137
Practice Address - Fax:508-477-0361
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH26674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist