Provider Demographics
NPI:1336434240
Name:STEWART, REBECCA ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:STEWART
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 1:585 NORTHTOWN DR NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-1044
Mailing Address - Country:US
Mailing Address - Phone:763-780-7350
Mailing Address - Fax:763-784-3626
Practice Address - Street 1:585 NORTHTOWN DR NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-1044
Practice Address - Country:US
Practice Address - Phone:763-780-7350
Practice Address - Fax:763-784-3626
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16273-40183500000X
MN119770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist