Provider Demographics
NPI:1003198722
Name:HEDRICK, STEPHANI LYN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANI
Middle Name:LYN
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 KIRKGATE CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-4802
Mailing Address - Country:US
Mailing Address - Phone:317-502-2590
Mailing Address - Fax:
Practice Address - Street 1:555 WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1321
Practice Address - Country:US
Practice Address - Phone:317-774-8346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019728A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist