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General NPI Number Information
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NPI Number | 1689127300
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Entity Type | Individual
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Provider Name | JENNIFER LYNN STELLOH
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Gender | Female
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 617 N WILLIAMS ST
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City | MANCELONA
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State | MI
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Zip | 49659-9766
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Country | US
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Telephone | 231-587-8491
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Fax |
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Provider Business Mailing Address
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Address Line | 2425 ORCHARD CIRCLE DR APT 15
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-1550
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Country | US
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Telephone | 616-885-0034
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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 | 5302041365
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License Number State | MI
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