Provider Demographics
NPI:1023277894
Name:MARTIN, STEPHANIE RAE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:RAE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:RAE
Other - Last Name:SCHUCKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20500 SW HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:MARTELL
Mailing Address - State:NE
Mailing Address - Zip Code:68404-6197
Mailing Address - Country:US
Mailing Address - Phone:308-870-1021
Mailing Address - Fax:
Practice Address - Street 1:20500 SW HOLLOW CT
Practice Address - Street 2:
Practice Address - City:MARTELL
Practice Address - State:NE
Practice Address - Zip Code:68404-6197
Practice Address - Country:US
Practice Address - Phone:308-870-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12692183500000X
WAPH00070677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist