Provider Demographics
NPI:1255668612
Name:DUNHAM, STEPHEN MATTHEW (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MATTHEW
Last Name:DUNHAM
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 1:186 BENT OAK DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-5003
Mailing Address - Country:US
Mailing Address - Phone:336-775-2243
Mailing Address - Fax:
Practice Address - Street 1:1015 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-5876
Practice Address - Country:US
Practice Address - Phone:336-474-6936
Practice Address - Fax:336-474-6945
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist