Provider Demographics
NPI:1518686245
Name:FENDT, STEPHEN GEORGE
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GEORGE
Last Name:FENDT
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 1:112 W VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6123
Mailing Address - Country:US
Mailing Address - Phone:610-719-7338
Mailing Address - Fax:
Practice Address - Street 1:225 BRIERHILL DR
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-4941
Practice Address - Country:US
Practice Address - Phone:410-420-2053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEAA-0015836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist