Provider Demographics
NPI:1659615631
Name:FORD, STEPHEN MATTHEW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MATTHEW
Last Name:FORD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 INDUSTRIAL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-5820
Mailing Address - Country:US
Mailing Address - Phone:207-459-1693
Mailing Address - Fax:
Practice Address - Street 1:108 INDUSTRIAL WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1082
Practice Address - Country:US
Practice Address - Phone:207-878-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5977183500000X
MAPH233258183500000X
CA68867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist