Provider Demographics
NPI:1043567803
Name:WIEMEIER, STEPHANIE M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:M
Last Name:WIEMEIER
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 1:34 ELM DR
Mailing Address - Street 2:
Mailing Address - City:PENNELLVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13132-3146
Mailing Address - Country:US
Mailing Address - Phone:315-668-6789
Mailing Address - Fax:
Practice Address - Street 1:736 IRVING AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1687
Practice Address - Country:US
Practice Address - Phone:315-470-7631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-12
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist