Provider Demographics
NPI:1598561342
Name:STILTNER, SALLY (CPHT)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:STILTNER
Suffix:
Gender:
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 RICHMOND RD N STE A
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1133
Mailing Address - Country:US
Mailing Address - Phone:859-986-4521
Mailing Address - Fax:
Practice Address - Street 1:402 RICHMOND RD N STE A
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1133
Practice Address - Country:US
Practice Address - Phone:859-986-4521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT00010119183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician