MEDICARE: DR. STEPHANIE WHEELER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	49481	FL

General Provider Information

NPI Number	:	1689912040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE WHEELER PHARMD

Provider Business Mailing Address
First Line	:	1660 TAYLOR RD
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-6753
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 TAYLOR RD
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-6753
Country	:	US
Telephone Number	:	386-756-6175
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2013
Last Update Date	:	01/19/2013

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