Provider Demographics
NPI:1346901147
Name:MOSS, STEPHANIE YOUNG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:YOUNG
Last Name:MOSS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:CLOTIEL
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3419 N. PENNSYLVANIA ST.
Mailing Address - Street 2:UNIT A1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-3477
Mailing Address - Country:US
Mailing Address - Phone:317-490-9088
Mailing Address - Fax:
Practice Address - Street 1:3419 N. PENNSYLVANIA ST.
Practice Address - Street 2:UNIT A1
Practice Address - City:INDIANAOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-3477
Practice Address - Country:US
Practice Address - Phone:317-490-9088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020387A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty