Provider Demographics
NPI:1144694191
Name:EDINGTON, STEFANIE JANEEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:JANEEN
Last Name:EDINGTON
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:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:PENTWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49449-0351
Mailing Address - Country:US
Mailing Address - Phone:231-736-9089
Mailing Address - Fax:
Practice Address - Street 1:26100 VREELAND RD
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:MI
Practice Address - Zip Code:48134-1692
Practice Address - Country:US
Practice Address - Phone:734-783-8765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist