Provider Demographics
NPI:1346606647
Name:STAIRS, VERN (RPH)
Entity Type:Individual
Prefix:
First Name:VERN
Middle Name:
Last Name:STAIRS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476999 US-95
Mailing Address - Street 2:WALMART
Mailing Address - City:PONDERAY
Mailing Address - State:ID
Mailing Address - Zip Code:83852
Mailing Address - Country:US
Mailing Address - Phone:208-265-4490
Mailing Address - Fax:
Practice Address - Street 1:476999 US-95
Practice Address - Street 2:WALMART SUPERCENTER
Practice Address - City:PONDERAY
Practice Address - State:ID
Practice Address - Zip Code:83852
Practice Address - Country:US
Practice Address - Phone:208-265-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP7403183500000X
TX47529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist