Provider Demographics
NPI:1215409172
Name:BAYER, STEPHEN CHAD (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CHAD
Last Name:BAYER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:CHAD
Other - Middle Name:
Other - Last Name:BAYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:722 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4668
Mailing Address - Country:US
Mailing Address - Phone:405-372-6120
Mailing Address - Fax:
Practice Address - Street 1:722 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4668
Practice Address - Country:US
Practice Address - Phone:405-372-6120
Practice Address - Fax:405-372-2833
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK14212OtherSTATE BOARD OF PHARMACY LICENSE