1871992990 NPI number — MRS. JENNIFER BIANCA STEINER RPH

Table of content: MRS. JENNIFER BIANCA STEINER RPH (NPI 1871992990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871992990 NPI number — MRS. JENNIFER BIANCA STEINER RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEINER
Provider First Name:
JENNIFER
Provider Middle Name:
BIANCA
Provider Name Prefix Text:
MRS.
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:
BATES
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
BIANCA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871992990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2941 ZION LN
Provider Second Line Business Mailing Address:
APT 104
Provider Business Mailing Address City Name:
CASPER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82609-5141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-234-9379
Provider Business Mailing Address Fax Number:
307-234-9424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1071 CY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-234-9379
Provider Business Practice Location Address Fax Number:
307-234-9424
Provider Enumeration Date:
08/14/2014

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:  3747 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3747 . This is a "WYOMING PHARMACY LICENSE" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




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