Provider Demographics
NPI:1538481460
Name:WORTHINGTON, STEPHEN THOMAS
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:THOMAS
Last Name:WORTHINGTON
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 1:25 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:CROPWELL
Mailing Address - State:AL
Mailing Address - Zip Code:35054-3825
Mailing Address - Country:US
Mailing Address - Phone:205-338-3607
Mailing Address - Fax:205-338-8388
Practice Address - Street 1:803 MATRTIN ST S
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35128
Practice Address - Country:US
Practice Address - Phone:205-884-2703
Practice Address - Fax:205-338-8388
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist