Provider Demographics
NPI:1144400961
Name:DELANCEY, STEPHANIE ANN (PHARMD, DCS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANN
Last Name:DELANCEY
Suffix:
Gender:F
Credentials:PHARMD, DCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1262 DIX AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-9618
Mailing Address - Country:US
Mailing Address - Phone:518-747-0292
Mailing Address - Fax:518-747-9451
Practice Address - Street 1:1262 DIX AVE
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-9618
Practice Address - Country:US
Practice Address - Phone:518-747-0292
Practice Address - Fax:518-747-9451
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20 049045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00361344Medicaid