Provider Demographics
NPI:1902371370
Name:STUPARITZ, STEPHANIE RAE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAE
Last Name:STUPARITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5208 THOMS RUN RD
Mailing Address - Street 2:
Mailing Address - City:PRESTO
Mailing Address - State:PA
Mailing Address - Zip Code:15142-1114
Mailing Address - Country:US
Mailing Address - Phone:412-508-6903
Mailing Address - Fax:
Practice Address - Street 1:103 W ALLEGHENY RD
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:PA
Practice Address - Zip Code:15126-9779
Practice Address - Country:US
Practice Address - Phone:724-695-7317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP452857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist