Provider Demographics
NPI:1831216050
Name:GEORGE, STEPHANIE ANN (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:GOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2127 N EAGLE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE STATION
Mailing Address - State:MO
Mailing Address - Zip Code:65619
Mailing Address - Country:US
Mailing Address - Phone:417-576-7932
Mailing Address - Fax:
Practice Address - Street 1:1454 E REPUBLIC RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6507
Practice Address - Country:US
Practice Address - Phone:417-886-6880
Practice Address - Fax:417-886-0042
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006009502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist