Provider Demographics
NPI:1992087696
Name:AMMANN, STEPHANIE A (PHARMD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:AMMANN
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 1:2702 CONEFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-9701
Mailing Address - Country:US
Mailing Address - Phone:785-830-9499
Mailing Address - Fax:
Practice Address - Street 1:3421 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3200
Practice Address - Country:US
Practice Address - Phone:785-841-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist