Provider Demographics
NPI:1043593114
Name:STEPHENSON, GABRIEL A (RPH)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:A
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 OLD HALLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-4202
Mailing Address - Country:US
Mailing Address - Phone:314-741-8688
Mailing Address - Fax:314-741-7019
Practice Address - Street 1:12400 OLD HALLS FERRY RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-4202
Practice Address - Country:US
Practice Address - Phone:314-741-8688
Practice Address - Fax:314-741-7019
Is Sole Proprietor?:No
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999141495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist