Provider Demographics
NPI:1154923571
Name:CORWIN, STEPHANIE BROOK (PHARMD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BROOK
Last Name:CORWIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3744 ASPYN LN N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4879
Mailing Address - Country:US
Mailing Address - Phone:701-306-7406
Mailing Address - Fax:
Practice Address - Street 1:415 34TH ST N
Practice Address - Street 2:
Practice Address - City:DILWORTH
Practice Address - State:MN
Practice Address - Zip Code:56529-1801
Practice Address - Country:US
Practice Address - Phone:218-233-9833
Practice Address - Fax:218-233-9836
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist