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General NPI Number Information
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NPI Number | 1720705049
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Entity Type | Individual
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Provider Name | STEPHANIE OLDHAM
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Gender | Female
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Dates
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Enumeration Date | 10/26/2022
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 8335 WESTCHESTER DR
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City | DALLAS
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State | TX
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Zip | 75225-5716
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Country | US
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Telephone | 214-361-7118
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Fax |
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Provider Business Mailing Address
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Address Line | 4341 MYERWOOD LN
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City | DALLAS
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State | TX
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Zip | 75244-7442
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Country | US
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Telephone | 405-657-6991
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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 | 34005
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License Number State | TX
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