Provider Demographics
NPI:1407210115
Name:SURPLUS, STEPHEN PAUL
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PAUL
Last Name:SURPLUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 GAP NEWPORT PIKE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19311-9513
Mailing Address - Country:US
Mailing Address - Phone:610-268-8578
Mailing Address - Fax:610-268-8473
Practice Address - Street 1:851 GAP NEWPORT PIKE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:PA
Practice Address - Zip Code:19311
Practice Address - Country:US
Practice Address - Phone:610-268-8578
Practice Address - Fax:610-268-8473
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist