MEDICARE: MR. GABRIEL A STEPHENSON RPH

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
1	183500000X	Pharmacist	1999141495	MO

General Provider Information

NPI Number	:	1043593114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GABRIEL A STEPHENSON RPH

Provider Business Mailing Address
First Line	:	12400 OLD HALLS FERRY RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-4202
Country	:	US
Telephone Number	:	314-741-8688
Fax Number	:	314-741-7019

Provider Business Practice Location Address
First Line	:	12400 OLD HALLS FERRY RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-4202
Country	:	US
Telephone Number	:	314-741-8688
Fax Number	:	314-741-7019

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2011
Last Update Date	:	09/24/2011

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