Healthcare Provider Details

I. General information

NPI: 1992131239
Provider Name (Legal Business Name): MICHAEL STUFFLEBEAM RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 OLD ROUTE 146
HALFMOON NY
12065-2912
US

IV. Provider business mailing address

121 OLD ROUTE 146
HALFMOON NY
12065-2912
US

V. Phone/Fax

Practice location:
  • Phone: 518-371-5842
  • Fax: 518-371-5931
Mailing address:
  • Phone: 518-371-5842
  • Fax: 518-371-5931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number058059
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: