Healthcare Provider Details

I. General information

NPI: 1154968352
Provider Name (Legal Business Name): STEFANIE RENE HULCE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E MORGAN ST
KOKOMO IN
46901-2357
US

IV. Provider business mailing address

1624 WYNTERBROOKE DR
KOKOMO IN
46901-0709
US

V. Phone/Fax

Practice location:
  • Phone: 765-452-0552
  • Fax:
Mailing address:
  • Phone: 765-438-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26027073A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: