Provider Demographics
NPI:1366607202
Name:MAHANEY, STEPHANIE LYNN (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:MAHANEY
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 1:4376 CORDOVA DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9049
Mailing Address - Country:US
Mailing Address - Phone:330-414-0737
Mailing Address - Fax:
Practice Address - Street 1:4376 CORDOVA DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-9049
Practice Address - Country:US
Practice Address - Phone:330-414-0737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03129393183500000X
OH06-0-05344390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program