Provider Demographics
NPI:1093000903
Name:STOCKDALE, STEVEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:STOCKDALE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S HAVANA ST
Mailing Address - Street 2:T1413
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4014
Mailing Address - Country:US
Mailing Address - Phone:303-755-6614
Mailing Address - Fax:303-755-6614
Practice Address - Street 1:1400 S HAVANA ST
Practice Address - Street 2:T1413
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4014
Practice Address - Country:US
Practice Address - Phone:303-755-6614
Practice Address - Fax:303-755-6614
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist