Healthcare Provider Details

I. General information

NPI: 1053084582
Provider Name (Legal Business Name): RACHEL ANNE STUMPHAUZER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 LINCOLN WAY STE 211
COEUR D ALENE ID
83814-2527
US

IV. Provider business mailing address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-5500
  • Fax: 208-625-5501
Mailing address:
  • Phone: 208-625-5500
  • Fax: 208-625-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP9553
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number2019025933
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberP9553
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: