Provider Demographics
NPI:1356221808
Name:MCCULLOUGH ROBERTS, STEPHANIE RACHELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RACHELLE
Last Name:MCCULLOUGH ROBERTS
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 1:698 YELLOWSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9322
Mailing Address - Country:US
Mailing Address - Phone:307-527-6221
Mailing Address - Fax:307-527-6667
Practice Address - Street 1:698 YELLOWSTONE AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9322
Practice Address - Country:US
Practice Address - Phone:307-527-6221
Practice Address - Fax:307-527-6667
Is Sole Proprietor?:No
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist