Provider Demographics
NPI:1952651036
Name:BASSETT, STEPHANIE LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:BASSETT
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 1:2930 MOUNTAIN LION DR APT 306
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-8960
Mailing Address - Country:US
Mailing Address - Phone:307-760-7638
Mailing Address - Fax:
Practice Address - Street 1:2600 11TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-8441
Practice Address - Country:US
Practice Address - Phone:970-475-0554
Practice Address - Fax:970-475-0644
Is Sole Proprietor?:No
Enumeration Date:2012-09-15
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0019590183500000X
WY3578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist