Provider Demographics
NPI:1386248698
Name:JARRETT, STEPHANIE (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:JARRETT
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5702 SHEPHERD ST
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-2284
Mailing Address - Country:US
Mailing Address - Phone:850-628-1796
Mailing Address - Fax:
Practice Address - Street 1:2936 COUNCIL TREE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-6300
Practice Address - Country:US
Practice Address - Phone:970-530-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45355183500000X
COPHA.0023230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist