1801120738 NPI number — STEPHANIE LINDSEY FITZPATRICK RPH

Table of content: STEPHANIE LINDSEY FITZPATRICK RPH (NPI 1801120738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801120738 NPI number — STEPHANIE LINDSEY FITZPATRICK RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITZPATRICK
Provider First Name:
STEPHANIE
Provider Middle Name:
LINDSEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LINDSEY
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801120738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5811 PROSPERITY CHURCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-948-0235
Provider Business Mailing Address Fax Number:
704-948-0399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5811 PROSPERITY CHURCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-948-0235
Provider Business Practice Location Address Fax Number:
704-948-0399
Provider Enumeration Date:
09/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  18499 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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