Provider Demographics
NPI:1235613571
Name:HICKEY, STEFANIE ANN KRAYCAR
Entity Type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:ANN KRAYCAR
Last Name:HICKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 SIMPSON FERRY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-3544
Mailing Address - Country:US
Mailing Address - Phone:717-591-9565
Mailing Address - Fax:
Practice Address - Street 1:5301 SIMPSON FERRY RD STE 101
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3544
Practice Address - Country:US
Practice Address - Phone:717-591-9565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-22
Last Update Date:2018-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist