Provider Demographics
NPI:1891395612
Name:VORTMAN, STEPHANIE D (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:VORTMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 STATE ROUTE 23
Mailing Address - Street 2:PHARMACY AT WALMART
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457
Mailing Address - Country:US
Mailing Address - Phone:973-835-5912
Mailing Address - Fax:
Practice Address - Street 1:48 STATE ROUTE 23
Practice Address - Street 2:PHARMACY AT WALMART
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457
Practice Address - Country:US
Practice Address - Phone:973-835-5912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03303800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist