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General NPI Number Information
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NPI Number | 1578194692
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Entity Type | Individual
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Provider Name | STEPHANIE LEE GARTRELL
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Gender | Female
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Dates
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Enumeration Date | 01/28/2020
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 8111 S EMERSON AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-8601
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Country | US
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Telephone | 317-528-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 7533 KIDWELL DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46239-6836
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Country | US
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Telephone | 317-502-0259
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26026275A
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License Number State | IN
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