Provider Demographics
NPI:1891197414
Name:EBERHARDT, STEFANIE LAUREN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:LAUREN
Last Name:EBERHARDT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:STEFANIE
Other - Middle Name:LAUREN
Other - Last Name:DRAHUSCHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:675 N MAIN ST
Mailing Address - Street 2:STE 315
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-3049
Mailing Address - Country:US
Mailing Address - Phone:412-496-9979
Mailing Address - Fax:
Practice Address - Street 1:3703 LAWNDALE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-3001
Practice Address - Country:US
Practice Address - Phone:336-540-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24436183500000X
PARP449165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist