Healthcare Provider Details

I. General information

NPI: 1093773772
Provider Name (Legal Business Name): STEPHEN D PROPER R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPRINGS RD
BEDFORD MA
01730-1114
US

IV. Provider business mailing address

4A PHILLIPS AVE
WILMINGTON MA
01887-2026
US

V. Phone/Fax

Practice location:
  • Phone: 781-687-2780
  • Fax:
Mailing address:
  • Phone: 781-687-2780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number19947
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: