Provider Demographics
NPI:1336422203
Name:STEPHANAKIS, REBECCA LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEE
Last Name:STEPHANAKIS
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 1:1228 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-4194
Mailing Address - Country:US
Mailing Address - Phone:781-233-6768
Mailing Address - Fax:
Practice Address - Street 1:841 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-2322
Practice Address - Country:US
Practice Address - Phone:781-592-2248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH27531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist