Provider Demographics
NPI:1942692918
Name:KURTZ, STEPHANIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KURTZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:STOCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3672 SHUTESBURY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7513
Mailing Address - Country:US
Mailing Address - Phone:317-797-4119
Mailing Address - Fax:
Practice Address - Street 1:450 AZALEA SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-7321
Practice Address - Country:US
Practice Address - Phone:843-871-6935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist