Provider Demographics
NPI:1053650614
Name:BAYENS, STEPHEN DOUGLAS (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:BAYENS
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 1:7338 MEADOW VW
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5474
Mailing Address - Country:US
Mailing Address - Phone:303-929-3456
Mailing Address - Fax:
Practice Address - Street 1:7338 MEADOW VW
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5474
Practice Address - Country:US
Practice Address - Phone:303-929-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10465OtherPHARMACIST LICENSE