MEDICARE: MR. STEPHEN PAUL NORTHRUP RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	06744	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06744	OTHER	NC	PHARMACIST LICENSE NUMBER

General Provider Information

NPI Number	:	1811296676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN PAUL NORTHRUP RPH

Provider Business Mailing Address
First Line	:	2005 NORTHWEST BLVD
Second Line	:
City	:	NEWTON
State	:	NC
Zip	:	28658-3721
Country	:	US
Telephone Number	:	828-464-9393
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 NORTHWEST BLVD
Second Line	:
City	:	NEWTON
State	:	NC
Zip	:	28658-3721
Country	:	US
Telephone Number	:	828-464-9393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2011
Last Update Date	:	03/19/2011

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