Healthcare Provider Details

I. General information

NPI: 1114603099
Provider Name (Legal Business Name): STELLAR FACKLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 GENDER RD
CANAL WINCHESTER OH
43110-9739
US

IV. Provider business mailing address

5000 E MAIN ST
COLUMBUS OH
43213-2440
US

V. Phone/Fax

Practice location:
  • Phone: 614-235-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03443467
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: