Provider Demographics
NPI:1992050389
Name:ALTHOFF, STEPHANIE ANN (PHARMD)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ANN
Last Name:ALTHOFF
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 1:603 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057
Mailing Address - Country:US
Mailing Address - Phone:507-645-4489
Mailing Address - Fax:
Practice Address - Street 1:603 DIVISION ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057
Practice Address - Country:US
Practice Address - Phone:507-645-4489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-21
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist