Provider Demographics
NPI:1780203844
Name:STOCK, STEPHANIE JANE (BS PHARM)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JANE
Last Name:STOCK
Suffix:
Gender:F
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 HICKORY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BUCKINGHAM
Mailing Address - State:IA
Mailing Address - Zip Code:50612-9749
Mailing Address - Country:US
Mailing Address - Phone:641-751-3853
Mailing Address - Fax:319-232-0926
Practice Address - Street 1:1334 FLAMMANG DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-4366
Practice Address - Country:US
Practice Address - Phone:319-232-3514
Practice Address - Fax:319-232-0926
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist