Provider Demographics
NPI:1669884870
Name:HINES, STEPHANIE MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:HINES
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 1:8715 W HIGHWAY 71 APT 5207
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-0037
Mailing Address - Country:US
Mailing Address - Phone:520-331-1723
Mailing Address - Fax:
Practice Address - Street 1:1137 S DOBSON RD # 10
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-3902
Practice Address - Country:US
Practice Address - Phone:480-964-1411
Practice Address - Fax:480-610-8152
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019243183500000X
TX72086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist