Healthcare Provider Details

I. General information

NPI: 1891675526
Provider Name (Legal Business Name): STEPHEN OGDEN HEGENAUER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22101 MOROSS RD
DETROIT MI
48236-2148
US

IV. Provider business mailing address

915 FARMDALE ST
FERNDALE MI
48220-1852
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302417739
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: