Provider Demographics
NPI:1801064365
Name:MICARE, STEFANIE
Entity type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:
Last Name:MICARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 STANIAK RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118-3502
Mailing Address - Country:US
Mailing Address - Phone:518-664-4749
Mailing Address - Fax:
Practice Address - Street 1:1440 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COLONIE
Practice Address - State:NY
Practice Address - Zip Code:12205-5118
Practice Address - Country:US
Practice Address - Phone:518-489-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040830183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist