Healthcare Provider Details

I. General information

NPI: 1023598620
Provider Name (Legal Business Name): STEFANI LYNNE MCMILLIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEFANI LYNNE TERRAZZANO

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 PURCHASE ST
NEW BEDFORD MA
02740-6232
US

IV. Provider business mailing address

4 CRAINE RD
EAST HAMPSTEAD NH
03826-5410
US

V. Phone/Fax

Practice location:
  • Phone: 508-992-2422
  • Fax:
Mailing address:
  • Phone: 781-439-1685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH238263
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHCY-00943
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: