Provider Demographics
NPI:1821758368
Name:THAYER, STEFANIE ANN (PHARM D)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:ANN
Last Name:THAYER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:ANN
Other - Last Name:THAYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:101 E HALL OF FAME AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-5425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 E HALL OF FAME AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-5425
Practice Address - Country:US
Practice Address - Phone:405-707-0287
Practice Address - Fax:405-707-0761
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-25
Last Update Date:2021-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy