MEDICARE: DR. STEPHANIE HAN PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	65108	CA

General Provider Information

NPI Number	:	1598228066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE HAN PHARM D

Provider Business Mailing Address
First Line	:	4150 REGENTS PARK ROW STE 155
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-9179
Country	:	US
Telephone Number	:	858-774-8003
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 REGENTS PARK ROW STE 155
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-9179
Country	:	US
Telephone Number	:	858-774-8003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2019
Last Update Date	:	04/10/2019

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