Provider Demographics
NPI:1285066175
Name:THIMM, STEPHANIE MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:THIMM
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 1:2740 N REGENCY PARK
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4527
Mailing Address - Country:US
Mailing Address - Phone:316-681-2181
Mailing Address - Fax:316-681-0277
Practice Address - Street 1:2740 N REGENCY PARK
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4527
Practice Address - Country:US
Practice Address - Phone:316-681-2181
Practice Address - Fax:316-681-0277
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14853183500000X
MO2010025229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist