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NPI Code Detail

MEDICARE: MR. STEPHEN PETER STEPHEN R.PH.

MEDICARE: MR. STEPHEN PETER STEPHEN R.PH.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist011937LA

General Provider Information

NPI Number : 1003812058
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STEPHEN PETER STEPHEN R.PH.
Provider Business Mailing Address
First Line : 322 CLEMSON CIR
Second Line :
City : TYLER
State : TX
Zip : 75703-4706
Country : US
Telephone Number : 903-509-8847
Fax Number :
Provider Business Practice Location Address
First Line : 1125 N PINE ST
Second Line :
City : DERIDDER
State : LA
Zip : 70634-2819
Country : US
Telephone Number : 337-462-5796
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2005
Last Update Date : 08/19/2014

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