Healthcare Provider Details

I. General information

NPI: 1366864753
Provider Name (Legal Business Name): STEPHANIE KEHLE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2014
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8151 E 32ND ST
YUMA AZ
85365-8401
US

IV. Provider business mailing address

8151 E 32ND ST
YUMA AZ
85365-8401
US

V. Phone/Fax

Practice location:
  • Phone: 928-344-6175
  • Fax: 928-344-2145
Mailing address:
  • Phone: 928-344-6175
  • Fax: 928-344-2145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14862
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: