MEDICARE: STEPHANIE LYN DEMMER PHARM.D., 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	PH60153886	WA

General Provider Information

NPI Number	:	1720398795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LYN DEMMER PHARM.D., RPH

Provider Business Mailing Address
First Line	:	907 W 26TH AVE
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99337-4258
Country	:	US
Telephone Number	:	509-308-8339
Fax Number	:

Provider Business Practice Location Address
First Line	:	1321 N COLUMBIA CENTER BLVD
Second Line	:	SUITE 845
City	:	KENNEWICK
State	:	WA
Zip	:	99336-7689
Country	:	US
Telephone Number	:	509-783-3413
Fax Number	:	509-735-2803

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

Provider Enumeration Date	:	10/08/2010
Last Update Date	:	10/08/2010

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