Provider Demographics
NPI:1558147918
Name:EPSTEIN, STEPHEN
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:EPSTEIN
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 1:15320 NW GAINESVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:REDDICK
Mailing Address - State:FL
Mailing Address - Zip Code:32686
Mailing Address - Country:US
Mailing Address - Phone:352-591-1116
Mailing Address - Fax:352-591-3003
Practice Address - Street 1:15320 NW GAINESVILLE ROAD
Practice Address - Street 2:
Practice Address - City:REDDICK
Practice Address - State:FL
Practice Address - Zip Code:32686
Practice Address - Country:US
Practice Address - Phone:352-591-1116
Practice Address - Fax:352-591-3003
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist