Healthcare Provider Details

I. General information

NPI: 1548795446
Provider Name (Legal Business Name): STEPHON MCGREW PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 S YOSEMITE ST
CENTENNIAL CO
80112-1418
US

IV. Provider business mailing address

2201 N URSULA ST APT 224
AURORA CO
80045-7437
US

V. Phone/Fax

Practice location:
  • Phone: 303-843-7600
  • Fax:
Mailing address:
  • Phone: 510-495-7451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number21536
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: