Healthcare Provider Details

I. General information

NPI: 1740958990
Provider Name (Legal Business Name): STEPHEN RIFFON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 TARGET WAY
MORGANTOWN WV
26501
US

IV. Provider business mailing address

436 AARONS CREEK RD
MORGANTOWN WV
26508-9564
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-5581
  • Fax:
Mailing address:
  • Phone: 304-906-9919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0012742
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: