Provider Demographics
NPI:1437558392
Name:WANTOU SIANTOU, STEPHANE (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEPHANE
Middle Name:
Last Name:WANTOU SIANTOU
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 1:4901 INDIAN HEAD HWY
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-2010
Mailing Address - Country:US
Mailing Address - Phone:301-839-3400
Mailing Address - Fax:
Practice Address - Street 1:4901 INDIAN HEAD HWY
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-2010
Practice Address - Country:US
Practice Address - Phone:301-839-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-16
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21156183500000X
VA0202211913183500000X
DCPH100001463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist