Healthcare Provider Details

I. General information

NPI: 1982220406
Provider Name (Legal Business Name): CATHERINE ALANE STAMM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2020
Last Update Date: 06/20/2020
Certification Date: 06/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 BUZZARD ROCK RD
FARMINGTON MO
63640-9703
US

IV. Provider business mailing address

221 BUZZARD ROCK RD
FARMINGTON MO
63640-9703
US

V. Phone/Fax

Practice location:
  • Phone: 630-207-7568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number043608
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: