MEDICARE: STEPHANIE LYNN SHRIDER RPH

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	03223038	OH

General Provider Information

NPI Number	:	1174127443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LYNN SHRIDER RPH

Provider Business Mailing Address
First Line	:	5-120 THE FLDS
Second Line	:
City	:	WILLIAMSTOWN
State	:	WV
Zip	:	26187-1804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 3RD ST
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-3109
Country	:	US
Telephone Number	:	740-373-2961
Fax Number	:

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

Provider Enumeration Date	:	11/26/2020
Last Update Date	:	11/26/2020

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