Provider Demographics
NPI:1013644376
Name:OSTIR, STEPHANIE LARISSA (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LARISSA
Last Name:OSTIR
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 1:907 SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CLIFFORD TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18470-7556
Mailing Address - Country:US
Mailing Address - Phone:570-807-6713
Mailing Address - Fax:
Practice Address - Street 1:5879 STATE ROUTE 92 STE 3
Practice Address - Street 2:
Practice Address - City:KINGSLEY
Practice Address - State:PA
Practice Address - Zip Code:18826-9707
Practice Address - Country:US
Practice Address - Phone:570-222-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP456958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist