MEDICARE: STEPHANIE VALERIE BISHOP R. PH. , PHARM D

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	03-3-26606	OH

General Provider Information

NPI Number	:	1811027279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE VALERIE BISHOP R. PH. , PHARM D

Provider Business Mailing Address
First Line	:	20025 STATE ROUTE 501
Second Line	:
City	:	WAPAKONETA
State	:	OH
Zip	:	45895-7633
Country	:	US
Telephone Number	:	419-657-6037
Fax Number	:

Provider Business Practice Location Address
First Line	:	1302 DEFIANCE ST
Second Line	:
City	:	WAPAKONETA
State	:	OH
Zip	:	45895-1081
Country	:	US
Telephone Number	:	419-738-5959
Fax Number	:

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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