Provider Demographics
NPI:1528731171
Name:HANAGAN, STEPHANIE JOY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JOY
Last Name:HANAGAN
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 1:1509 NORTHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2756
Mailing Address - Country:US
Mailing Address - Phone:847-668-3020
Mailing Address - Fax:
Practice Address - Street 1:10845 E 79TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-8919
Practice Address - Country:US
Practice Address - Phone:317-826-8790
Practice Address - Fax:317-826-8927
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029327A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist