Provider Demographics
NPI:1639423460
Name:STEPHEN, ABRAHAM K (RPH)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:K
Last Name:STEPHEN
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 1:5453 VICTORIA LN
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-3832
Mailing Address - Country:US
Mailing Address - Phone:510-223-9748
Mailing Address - Fax:
Practice Address - Street 1:774 ADMIRAL CALLAGHAN LN
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-3650
Practice Address - Country:US
Practice Address - Phone:707-554-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist