Provider Demographics
NPI:1942805189
Name:STALLONE, STEFANIE ANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:ANNE
Last Name:STALLONE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 GURLEY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1547
Mailing Address - Country:US
Mailing Address - Phone:718-541-8476
Mailing Address - Fax:
Practice Address - Street 1:4065 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2423
Practice Address - Country:US
Practice Address - Phone:718-317-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist