Provider Demographics
NPI:1861022261
Name:WUELLNER, STEPHANIE (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WUELLNER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:SAMPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:85 RICHARDS RUN
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9132
Mailing Address - Country:US
Mailing Address - Phone:937-974-6097
Mailing Address - Fax:
Practice Address - Street 1:4000 MIAMISBURG-CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342
Practice Address - Country:US
Practice Address - Phone:937-384-4844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03124773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist