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NPI Code Detail

MEDICARE: MRS. NICHOLE LEIGH STEPHANE R.PH.

MEDICARE: MRS. NICHOLE LEIGH STEPHANE R.PH.
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
1183500000XPharmacist116636-7MN

General Provider Information

NPI Number : 1427055565
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICHOLE LEIGH STEPHANE R.PH.
Provider Business Mailing Address
First Line : 3133 DEAN CT
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55416-4385
Country : US
Telephone Number : 612-927-4728
Fax Number :
Provider Business Practice Location Address
First Line : 711 KASOTA AVE SE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55414-2842
Country : US
Telephone Number : 612-672-5585
Fax Number : 612-672-5201
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 07/08/2007

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