Healthcare Provider Details

I. General information

NPI: 1053393710
Provider Name (Legal Business Name): STO-PHAR,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 W LIBERTY ST
SUMTER SC
29150-5240
US

IV. Provider business mailing address

35 W LIBERTY ST
SUMTER SC
29150-5240
US

V. Phone/Fax

Practice location:
  • Phone: 803-773-7283
  • Fax: 803-775-7908
Mailing address:
  • Phone: 803-773-7283
  • Fax: 803-775-7908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50-002451
License Number StateSC

VIII. Authorized Official

Name: WILLIAM LEWIS STOVER
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 803-773-7283