Provider Demographics
NPI:1215160056
Name:NYMAN, STEFANIE L (PHARMD, MPA)
Entity type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:L
Last Name:NYMAN
Suffix:
Gender:F
Credentials:PHARMD, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 W OLD SHAKOPEE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-2945
Mailing Address - Country:US
Mailing Address - Phone:952-252-1062
Mailing Address - Fax:
Practice Address - Street 1:3916 W OLD SHAKOPEE RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-2945
Practice Address - Country:US
Practice Address - Phone:952-252-1062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119583183500000X
IA20813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist