Provider Demographics
NPI:1417786112
Name:CLINE, STEPHANIE MAXINE (RPH)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MAXINE
Last Name:CLINE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:MAXINE
Other - Last Name:RODNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:919 W MERCURY BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-4322
Mailing Address - Country:US
Mailing Address - Phone:757-827-2995
Mailing Address - Fax:
Practice Address - Street 1:919 W MERCURY BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-4322
Practice Address - Country:US
Practice Address - Phone:757-827-2995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.040009183500000X
VA02011945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist