Most Relevant Information
Provider Data
| NPI Number: | 1003812058 |
| Provider Name: | STEPHEN PETER STEPHEN R.PH. |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 011937 |
Most Important Dates
| Enumeration Date: | 06/23/2005 |
| Last Updated: | 08/19/2014 |
Provider Practice Location
1125 N PINE ST
DERIDDER
LA
706342819
Practice Location Phone/Fax
| Phone: | 3374625796 |
| Fax: |
Provider Mailing Location
322 CLEMSON CIR
TYLER
TX
757034706
Provider Mailing Phone/Fax
| Phone: | 9035098847 |
| Fax: |