Healthcare Provider Details

I. General information

NPI: 1831216050
Provider Name (Legal Business Name): STEPHANIE ANN GEORGE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE GOLD

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 E REPUBLIC RD
SPRINGFIELD MO
65804-6507
US

IV. Provider business mailing address

2127 N EAGLE VIEW DR
BROOKLINE STATION MO
65619
US

V. Phone/Fax

Practice location:
  • Phone: 417-886-6880
  • Fax: 417-886-0042
Mailing address:
  • Phone: 417-576-7932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2006009502
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: