Healthcare Provider Details

I. General information

NPI: 1649539230
Provider Name (Legal Business Name): JOHN PHILIP STOLL R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 01/21/2024
Certification Date: 01/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 E GREEN ST
CLARKTON NC
28433-5003
US

IV. Provider business mailing address

PO BOX 816
CLARKTON NC
28433-0816
US

V. Phone/Fax

Practice location:
  • Phone: 910-647-0437
  • Fax: 910-647-0696
Mailing address:
  • Phone: 910-647-0437
  • Fax: 910-647-0696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13988
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: