Provider Demographics
NPI:1295012904
Name:HARGIS, STEPHEN SCOTT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:SCOTT
Last Name:HARGIS
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 1:4740 ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-1755
Mailing Address - Country:US
Mailing Address - Phone:541-688-6569
Mailing Address - Fax:541-688-6608
Practice Address - Street 1:4740 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-1755
Practice Address - Country:US
Practice Address - Phone:541-688-6569
Practice Address - Fax:541-688-6608
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00011447183500000X
MT5684183500000X
ORRPH114471835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist