MEDICARE: MRS. FAYE L. STAHL 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
1	183500000X	Pharmacist	03-1-07127	OH

General Provider Information

NPI Number	:	1508856444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FAYE L. STAHL R. PH.

Provider Business Mailing Address
First Line	:	5267 PORTAGE DR
Second Line	:
City	:	VERMILION
State	:	OH
Zip	:	44089-1429
Country	:	US
Telephone Number	:	440-967-4832
Fax Number	:	440-967-1919

Provider Business Practice Location Address
First Line	:	5267 PORTAGE DR
Second Line	:
City	:	VERMILION
State	:	OH
Zip	:	44089-1429
Country	:	US
Telephone Number	:	440-967-4832
Fax Number	:	440-967-1919

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	07/08/2007

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