| NPI | 1912210683 |
|---|---|
| Former Name | STEPHANIE LYNN VICTOR |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 19709) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA rp442721) |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2010-07-22 |