Provider Demographics
NPI:1558961706
Name:SOSTAKOWSKI, STEPHANIE (PHARMD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SOSTAKOWSKI
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 1:485 AIRPORT HWY
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-8709
Mailing Address - Country:US
Mailing Address - Phone:419-337-8122
Mailing Address - Fax:419-337-8492
Practice Address - Street 1:485 AIRPORT HWY
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-8709
Practice Address - Country:US
Practice Address - Phone:419-337-8122
Practice Address - Fax:419-337-8492
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024426A183500000X
OH03227949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist