Provider Demographics
NPI:1992092035
Name:DIX, STEPHANIE KATHRYN (RPH)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:KATHRYN
Last Name:DIX
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GRAND CORNER AVE
Mailing Address - Street 2:T-1193
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-7305
Mailing Address - Country:US
Mailing Address - Phone:301-721-1830
Mailing Address - Fax:301-721-1830
Practice Address - Street 1:25 GRAND CORNER AVE
Practice Address - Street 2:T-1193
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-7305
Practice Address - Country:US
Practice Address - Phone:301-721-1830
Practice Address - Fax:301-721-1830
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist