Provider Demographics
NPI:1356033716
Name:CARANO, STEPHANIE W
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:W
Last Name:CARANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:S
Other - Last Name:WILKENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8616 RAINTREE RUN
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-2987
Mailing Address - Country:US
Mailing Address - Phone:330-507-8769
Mailing Address - Fax:
Practice Address - Street 1:10395 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:44442-9802
Practice Address - Country:US
Practice Address - Phone:330-542-2802
Practice Address - Fax:330-542-2802
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03213957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist