| 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 |