Provider Demographics
NPI:1942609011
Name:MCDANIEL, STEFANIE JEAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:JEAN
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 WORTHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7025
Mailing Address - Country:US
Mailing Address - Phone:240-699-0018
Mailing Address - Fax:240-699-0366
Practice Address - Street 1:3350 WORTHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7025
Practice Address - Country:US
Practice Address - Phone:240-699-0018
Practice Address - Fax:240-699-0366
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist