Provider Demographics
NPI:1033710389
Name:MAHLER, STEPHANIE H (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:H
Last Name:MAHLER
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 1:316 INDIAN RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-9034
Mailing Address - Country:US
Mailing Address - Phone:574-243-9707
Mailing Address - Fax:
Practice Address - Street 1:316 INDIAN RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-9034
Practice Address - Country:US
Practice Address - Phone:574-243-9707
Practice Address - Fax:574-243-9807
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020195A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist