Provider Demographics
NPI:1881733715
Name:STAHL, MARCIA DETERS (RPH)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:DETERS
Last Name:STAHL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 MARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-9504
Mailing Address - Country:US
Mailing Address - Phone:585-798-1204
Mailing Address - Fax:
Practice Address - Street 1:142 E CENTER ST
Practice Address - Street 2:THE MEDICINE SHOPPE
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1621
Practice Address - Country:US
Practice Address - Phone:585-798-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist