Provider Demographics
NPI:1851988869
Name:COUTU, STEPHANIE MAE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MAE
Last Name:COUTU
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 1:44 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-2608
Mailing Address - Country:US
Mailing Address - Phone:978-868-8027
Mailing Address - Fax:
Practice Address - Street 1:226 BROADWAY
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-1893
Practice Address - Country:US
Practice Address - Phone:508-977-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist