Healthcare Provider Details

I. General information

NPI: 1558369868
Provider Name (Legal Business Name): NATHAN PAUL STOCKMAN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

5519 KNOLLCREST CT
DAYTON OH
45429-5913
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-2580
  • Fax: 937-208-2480
Mailing address:
  • Phone: 937-291-4042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-22372
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: