MEDICARE: DR. STEPHANIE LYNN PRO PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	18709	MD
2	183500000X	Pharmacist	A1-0003791	DE

General Provider Information

NPI Number	:	1043594856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE LYNN PRO PHARMD

Provider Business Mailing Address
First Line	:	21 SYCAMORE LN
Second Line	:
City	:	BEAR
State	:	DE
Zip	:	19701-6382
Country	:	US
Telephone Number	:	302-918-7066
Fax Number	:

Provider Business Practice Location Address
First Line	:	2556 PULASKI HWY
Second Line	:
City	:	NORTH EAST
State	:	MD
Zip	:	21901-2610
Country	:	US
Telephone Number	:	410-287-8887
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2011
Last Update Date	:	09/29/2011

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