Provider Demographics
NPI:1023598620
Name:MCMILLIAN, STEFANI LYNNE
Entity type:Individual
Prefix:
First Name:STEFANI
Middle Name:LYNNE
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEFANI
Other - Middle Name:LYNNE
Other - Last Name:TERRAZZANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 CRAINE RD
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03826-5410
Mailing Address - Country:US
Mailing Address - Phone:781-439-1685
Mailing Address - Fax:
Practice Address - Street 1:824 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6232
Practice Address - Country:US
Practice Address - Phone:508-992-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH238263183500000X
NHPHCY-00943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist