Provider Demographics
NPI:1417057993
Name:STOUT, COSIMO D (RPH)
Entity Type:Individual
Prefix:MR
First Name:COSIMO
Middle Name:D
Last Name:STOUT
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 1:937 STRATFORD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-3333
Mailing Address - Country:US
Mailing Address - Phone:610-974-8954
Mailing Address - Fax:
Practice Address - Street 1:400 N BEST AVE
Practice Address - Street 2:
Practice Address - City:WALNUTPORT
Practice Address - State:PA
Practice Address - Zip Code:18088-1208
Practice Address - Country:US
Practice Address - Phone:610-767-2541
Practice Address - Fax:610-767-2901
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029692L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist