=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043556681
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN BERNARD PHARM.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/01/2013
-----------------------------------------------------
Last Update Date | 12/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 413 RR1 RTE 611 SUITE 100
-----------------------------------------------------
City | TANNERSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18372-1837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-629-8554
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 SONGBIRD CT
-----------------------------------------------------
City | SAYLORSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18353-8689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-219-0855
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP446039
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------