Provider Demographics
NPI:1427461169
Name:STEFANATOS, KATHERINE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:STEFANATOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MACDADE BLVD
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:WOODLYN
Mailing Address - State:PA
Mailing Address - Zip Code:19094-1500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 MACDADE BLVD
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:WOODLYN
Practice Address - State:PA
Practice Address - Zip Code:19094-1500
Practice Address - Country:US
Practice Address - Phone:610-833-2242
Practice Address - Fax:610-833-3067
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040167L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist