Provider Demographics
NPI:1568798866
Name:WITTER, STEPHEN DALE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DALE
Last Name:WITTER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 HUNTERS XING
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6827
Mailing Address - Country:US
Mailing Address - Phone:301-287-6656
Mailing Address - Fax:919-387-6656
Practice Address - Street 1:808 AVIATION PKWY STE 900
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6662
Practice Address - Country:US
Practice Address - Phone:919-460-3967
Practice Address - Fax:919-460-8071
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist