Healthcare Provider Details

I. General information

NPI: 1215518907
Provider Name (Legal Business Name): STEPHANIE PUCHIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

578 VALLEY RD
WAYNE NJ
07470-3593
US

IV. Provider business mailing address

578 VALLEY RD
WAYNE NJ
07470-3593
US

V. Phone/Fax

Practice location:
  • Phone: 973-694-5522
  • Fax: 973-694-1751
Mailing address:
  • Phone: 973-694-5522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04051800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: