MEDICARE: ANNETTE STOLLER PHARM.D.

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	03223239	OH

General Provider Information

NPI Number	:	1053640938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE STOLLER PHARM.D.

Provider Business Mailing Address
First Line	:	4206 MACKENZIE CT
Second Line	:
City	:	MASON
State	:	OH
Zip	:	45040-4668
Country	:	US
Telephone Number	:	513-492-7860
Fax Number	:

Provider Business Practice Location Address
First Line	:	1119 WESTCHESTER WAY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-5040
Country	:	US
Telephone Number	:	513-383-4338
Fax Number	:

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

Provider Enumeration Date	:	12/23/2009
Last Update Date	:	02/11/2017

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