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General NPI Number Information
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NPI Number | 1013558469
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Entity Type | Individual
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Provider Name | STEPHEN PAUL SOUTHERN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 38627 BENRO DR
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City | DELMAR
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State | DE
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Zip | 19940-3572
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Country | US
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Telephone | 302-907-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 121 HORSEY AVE
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City | LAUREL
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State | DE
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Zip | 19956-1211
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Country | US
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Telephone | 410-739-8669
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | A1-0005454
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License Number State | DE
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