Healthcare Provider Details

I. General information

NPI: 1912376989
Provider Name (Legal Business Name): STEPHANIE HART PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 N MAIN ST
TUBA CITY AZ
86045
US

IV. Provider business mailing address

P.O. BOX 600 167 N MAIN ST
TUBA CITY AZ
86045
US

V. Phone/Fax

Practice location:
  • Phone: 928-283-2754
  • Fax: 928-283-2758
Mailing address:
  • Phone: 928-283-2754
  • Fax: 928-283-2758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS54129
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: