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General NPI Number Information
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NPI Number | 1396473799
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Entity Type | Individual
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Provider Name | STEPHANIE ALEXIS MAVRODIN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/12/2022
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 200 LOTHROP ST
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City | PITTSBURGH
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State | PA
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Zip | 15213-2536
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Country | US
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Telephone | 412-350-9328
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Fax |
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Provider Business Mailing Address
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Address Line | 5659 BEACON ST
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City | PITTSBURGH
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State | PA
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Zip | 15217-2011
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Country | US
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Telephone | 330-933-7967
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03439228
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP455313
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License Number State | PA
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