Provider Demographics
NPI:1831434885
Name:FRIEDMAN, STEPHANIE ILYSE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ILYSE
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ILYSE
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 S J ST
Mailing Address - Street 2:MS 01-79
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4933
Mailing Address - Country:US
Mailing Address - Phone:253-426-6692
Mailing Address - Fax:253-426-4949
Practice Address - Street 1:1717 S J ST
Practice Address - Street 2:MS 01-79
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4933
Practice Address - Country:US
Practice Address - Phone:253-426-6692
Practice Address - Fax:253-426-4949
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60281309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist