Individual
NYSSA STANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2825 E BARNETT RD, MEDFORD, OR 97504-8332
(541) 789-4460
Mailing address
2431 HIGHGATE ST APT 3, MEDFORD, OR 97501-7971
(928) 814-2639
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0014393
OR
Other
Enumeration date
09/07/2019
Last updated
09/07/2019
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