Provider Demographics
NPI:1447426507
Name:WANKO, STEPHEN JOHN (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JOHN
Last Name:WANKO
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 1:74 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2304
Mailing Address - Country:US
Mailing Address - Phone:201-437-6549
Mailing Address - Fax:
Practice Address - Street 1:2115 69TH ST
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4518
Practice Address - Country:US
Practice Address - Phone:201-434-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RIO1512300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist