Provider Demographics
NPI:1851955439
Name:WIENKERS, STEPHANIE (CLINICAL PHARMACIST)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WIENKERS
Suffix:
Gender:F
Credentials:CLINICAL PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 S FEDERAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-4235
Mailing Address - Country:US
Mailing Address - Phone:303-602-0083
Mailing Address - Fax:
Practice Address - Street 1:1339 S FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-4235
Practice Address - Country:US
Practice Address - Phone:303-602-0083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.00231591835P2201X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPHA.0023159OtherCOLORADO STATE BOARD OF PHARMACY
ORRPH-0017333OtherOREGON STATE BOARD OF PHARMACY