Healthcare Provider Details

I. General information

NPI: 1144018789
Provider Name (Legal Business Name): STEPHANIE TUPPER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 7TH AVE
FORT WORTH TX
76104-2733
US

IV. Provider business mailing address

1500 W ROSEDALE ST FL 4
FORT WORTH TX
76104-7403
US

V. Phone/Fax

Practice location:
  • Phone: 682-885-4000
  • Fax:
Mailing address:
  • Phone: 682-303-4486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number53638
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: