NPI | 1164918488 |
---|---|
Former Name | STEPHANIE LEE SOUTHARD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0021144) |
Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202214193) |
Enumeration Date | 2018-07-10 |
Last Update Date | 2018-07-10 |