MEDICARE: STEPHANIE LYNN KORNECHUK 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	PH45698	WA

General Provider Information

NPI Number	:	1457499675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LYNN KORNECHUK PHARMD

Provider Business Mailing Address
First Line	:	5132 BALTIC ST
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98332-9789
Country	:	US
Telephone Number	:	253-709-6799
Fax Number	:

Provider Business Practice Location Address
First Line	:	3913 63RD ST NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-5646
Country	:	US
Telephone Number	:	253-709-6799
Fax Number	:

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	12/29/2023

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