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General NPI Number Information
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NPI Number | 1669604161
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Entity Type | Individual
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Provider Name | STEPHANIE ANN ROUSH PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/17/2009
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Last Update Date | 05/09/2013
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Provider Practice Location Address
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Address Line | 6925 W 38TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-3905
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Country | US
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Telephone | 314-537-6372
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Fax |
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Provider Business Mailing Address
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Address Line | 175 FLOWER VALLEY SHOPPING CTR
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City | FLORISSANT
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State | MO
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Zip | 63033-1643
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Country | US
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Telephone | 314-837-8052
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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 | 2010029502
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License Number State | MO
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