Provider Demographics
NPI:1013484252
Name:OVER, STEPHANIE LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:OVER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:3499 BRUMBAUGH RD
Mailing Address - Street 2:
Mailing Address - City:NEW ENTERPRISE
Mailing Address - State:PA
Mailing Address - Zip Code:16664-8820
Mailing Address - Country:US
Mailing Address - Phone:814-766-0124
Mailing Address - Fax:814-766-0126
Practice Address - Street 1:3499 BRUMBAUGH RD
Practice Address - Street 2:
Practice Address - City:NEW ENTERPRISE
Practice Address - State:PA
Practice Address - Zip Code:16664-8820
Practice Address - Country:US
Practice Address - Phone:814-766-0124
Practice Address - Fax:814-766-0126
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040083L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA593781OtherNABP