Provider Demographics
NPI:1235331000
Name:STAEHLING, PHILIP STEPHEN (PD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:STEPHEN
Last Name:STAEHLING
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:MO
Mailing Address - Zip Code:64424-2415
Mailing Address - Country:US
Mailing Address - Phone:660-425-6459
Mailing Address - Fax:
Practice Address - Street 1:710 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MO
Practice Address - Zip Code:64673-1141
Practice Address - Country:US
Practice Address - Phone:660-748-7730
Practice Address - Fax:660-748-7733
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist