Provider Demographics
NPI:1275046179
Name:GIRGIS, STEPHEN (RPH, BCGP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:GIRGIS
Suffix:
Gender:M
Credentials:RPH, BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8041 HARTHAM PARK AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-9303
Mailing Address - Country:US
Mailing Address - Phone:919-457-3158
Mailing Address - Fax:
Practice Address - Street 1:8041 HARTHAM PARK AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-9303
Practice Address - Country:US
Practice Address - Phone:919-457-3158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC211891835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric