Basic Information
Provider Information | |||||||||
NPI: | 1609048891 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SODDERS | ||||||||
FirstName: | STEPHANIE | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHARMD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ROWE | ||||||||
OtherFirstName: | STEPHANIE | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PHARMD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1010 DELAFIELD RD, FLOOR 1 | ||||||||
Address2: | OUTPATIENT PHARMACY | ||||||||
City: | PITTSBURGH | ||||||||
State: | PA | ||||||||
PostalCode: | 152151802 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4128222222 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1010 DELAFIELD RD | ||||||||
Address2: | OUTPATIENT PHARMACY | ||||||||
City: | PITTSBURGH | ||||||||
State: | PA | ||||||||
PostalCode: | 152151802 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4128222222 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/27/2008 | ||||||||
LastUpdateDate: | 06/28/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/28/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 03-2-28012 | OH | N |   | Pharmacy Service Providers | Pharmacist |   | 1835P1200X | 03228012 | OH | Y |   | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.