Provider Demographics
NPI:1205128048
Name:DEVINE, STEPHANIE ANN (RPH)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:DEVINE
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 1:6000 EARLE BROWN DR
Mailing Address - Street 2:PHARMACY
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2506
Mailing Address - Country:US
Mailing Address - Phone:952-993-4800
Mailing Address - Fax:952-993-4888
Practice Address - Street 1:6000 EARLE BROWN DR
Practice Address - Street 2:PHARMACY
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2506
Practice Address - Country:US
Practice Address - Phone:952-993-4800
Practice Address - Fax:952-993-4888
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1156526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist