Provider Demographics
NPI:1053489401
Name:STEPHENS, MARK CHARLES (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:CHARLES
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 DREHERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ORWIGSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17961-9603
Mailing Address - Country:US
Mailing Address - Phone:570-640-1094
Mailing Address - Fax:
Practice Address - Street 1:297 DREHERSVILLE RD
Practice Address - Street 2:
Practice Address - City:ORWIGSBURG
Practice Address - State:PA
Practice Address - Zip Code:17961-9603
Practice Address - Country:US
Practice Address - Phone:570-640-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3279183500000X
PARP029878L183500000X
VT033.0003897183500000X
CTPCT.0011235183500000X
MAPH232445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist