Provider Demographics
NPI:1831483023
Name:ROSE, STEPHANIE LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LYNN
Last Name:ROSE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 E STONE DR
Mailing Address - Street 2:TARGET PHARMACY T-2332
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-5883
Mailing Address - Country:US
Mailing Address - Phone:423-578-1727
Mailing Address - Fax:
Practice Address - Street 1:2626 E STONE DR
Practice Address - Street 2:TARGET PHARMACY T-2332
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5883
Practice Address - Country:US
Practice Address - Phone:423-578-1727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000034548183500000X
VA0202209989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist