Healthcare Provider Details

I. General information

NPI: 1508856444
Provider Name (Legal Business Name): FAYE L. STAHL R. PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5267 PORTAGE DR
VERMILION OH
44089-1429
US

IV. Provider business mailing address

5267 PORTAGE DR
VERMILION OH
44089-1429
US

V. Phone/Fax

Practice location:
  • Phone: 440-967-4832
  • Fax: 440-967-1919
Mailing address:
  • Phone: 440-967-4832
  • Fax: 440-967-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-07127
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: