Provider Demographics
NPI:1518276484
Name:SIBICKY, STEPHANIE LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:SIBICKY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:HATTOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:140 THE FENWAY # R220
Mailing Address - Street 2:360 HUNTINGTON AVE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-3782
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 THE FENWAY # R220
Practice Address - Street 2:360 HUNTINGTON AVE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-3782
Practice Address - Country:US
Practice Address - Phone:617-323-3203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0011404183500000X
RIRPH04823183500000X
MAPH235752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist