Provider Demographics
NPI:1548534407
Name:PLUMM, STEPHANIE DIANE (RPH)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DIANE
Last Name:PLUMM
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:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-0581
Mailing Address - Country:US
Mailing Address - Phone:360-989-6201
Mailing Address - Fax:
Practice Address - Street 1:401 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9105
Practice Address - Country:US
Practice Address - Phone:360-666-5133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00015081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist