Provider Demographics
NPI:1053591784
Name:STAHL, JENNIFER GRETH (RPH)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GRETH
Last Name:STAHL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 RUIE RD
Mailing Address - Street 2:
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1941
Mailing Address - Country:US
Mailing Address - Phone:716-693-2632
Mailing Address - Fax:
Practice Address - Street 1:301 MEADOW DR
Practice Address - Street 2:
Practice Address - City:N TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-2819
Practice Address - Country:US
Practice Address - Phone:716-743-9481
Practice Address - Fax:716-743-9486
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist