Provider Demographics
NPI:1497818686
Name:RAUCH, STEPHEN KENT (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:KENT
Last Name:RAUCH
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 1:2505 PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-2719
Mailing Address - Country:US
Mailing Address - Phone:620-251-3137
Mailing Address - Fax:
Practice Address - Street 1:1205 W 8TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-3505
Practice Address - Country:US
Practice Address - Phone:620-251-3533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist