Healthcare Provider Details

I. General information

NPI: 1891197414
Provider Name (Legal Business Name): STEFANIE LAUREN EBERHARDT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEFANIE LAUREN DRAHUSCHAK PHARMD

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3703 LAWNDALE DR
GREENSBORO NC
27455-3001
US

IV. Provider business mailing address

675 N MAIN ST STE 315
WINSTON SALEM NC
27101-3049
US

V. Phone/Fax

Practice location:
  • Phone: 336-540-1344
  • Fax:
Mailing address:
  • Phone: 412-496-9979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24436
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP449165
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: