Healthcare Provider Details

I. General information

NPI: 1053575290
Provider Name (Legal Business Name): STEPHEN B SQUIRES B.S. PHARMACY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RIVENDELL CT
WINCHESTER VA
22603-8629
US

IV. Provider business mailing address

200 RIVENDELL CT
WINCHESTER VA
22603-8629
US

V. Phone/Fax

Practice location:
  • Phone: 540-545-8301
  • Fax: 540-545-8327
Mailing address:
  • Phone: 540-545-8301
  • Fax: 540-545-8327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202007678
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: