Healthcare Provider Details

I. General information

NPI: 1417956988
Provider Name (Legal Business Name): MARILYN RUTH STEBBINS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 PARNASSUS AVE # U503
SAN FRANCISCO CA
94143-2208
US

IV. Provider business mailing address

2608 CHATEAU LN
DAVIS CA
95616-6414
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-3955
  • Fax: 415-476-6632
Mailing address:
  • Phone: 530-753-8780
  • Fax: 530-753-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42044
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number42044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: