Provider Demographics
NPI:1659063162
Name:LADDY, STEPHEN S (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:S
Last Name:LADDY
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 1:66 KENDRICK LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7829
Mailing Address - Country:US
Mailing Address - Phone:917-608-5428
Mailing Address - Fax:
Practice Address - Street 1:66 KENDRICK LN
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-7829
Practice Address - Country:US
Practice Address - Phone:917-608-5428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027057-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist