Provider Demographics
NPI:1629630819
Name:STEPHAN, HOLLY MAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:MAY
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:MAY
Other - Last Name:KAMPENGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:711 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IN
Mailing Address - Zip Code:46072-1921
Mailing Address - Country:US
Mailing Address - Phone:765-675-3400
Mailing Address - Fax:
Practice Address - Street 1:711 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072-1921
Practice Address - Country:US
Practice Address - Phone:765-675-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025506A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26025506AOtherINDIANA BOARD OF PHARMACY