Provider Demographics
NPI:1568737237
Name:NORMAN, STEPHEN RANDALL (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RANDALL
Last Name:NORMAN
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 1:309 NORTHBAY DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9174
Mailing Address - Country:US
Mailing Address - Phone:205-382-2657
Mailing Address - Fax:601-499-2461
Practice Address - Street 1:136 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8701
Practice Address - Country:US
Practice Address - Phone:205-499-2460
Practice Address - Fax:601-499-2461
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10185183500000X
MST08898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist