Provider Demographics
NPI:1861606881
Name:STEM, THERESA ANNE (RPH)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ANNE
Last Name:STEM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DETA
Other - Middle Name:
Other - Last Name:STEM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:720 SW CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163
Mailing Address - Country:US
Mailing Address - Phone:509-334-1240
Mailing Address - Fax:
Practice Address - Street 1:430 SE BISHOP BLVD
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5503
Practice Address - Country:US
Practice Address - Phone:509-334-0819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00021891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist