Provider Demographics
NPI:1306238670
Name:WASSERMAN, STEPHANIE M
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:M
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARRONA-STEPHANIE
Other - Middle Name:
Other - Last Name:WASSERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:733 TAUNTON RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803
Mailing Address - Country:US
Mailing Address - Phone:610-380-3140
Mailing Address - Fax:
Practice Address - Street 1:4011 KENNETT PIKE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:DE
Practice Address - Zip Code:19807-2018
Practice Address - Country:US
Practice Address - Phone:024-275-6503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP449028183500000X
DEA1-0004725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist