Provider Demographics
NPI:1699392092
Name:VANHOUTEN, STEPHANIE SUSAN (PHARMD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SUSAN
Last Name:VANHOUTEN
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 1:1300 LYTLE LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2118
Mailing Address - Country:US
Mailing Address - Phone:937-409-3300
Mailing Address - Fax:
Practice Address - Street 1:401 W NORTH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2607
Practice Address - Country:US
Practice Address - Phone:937-324-5796
Practice Address - Fax:937-322-4516
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist