Provider Demographics
NPI:1689740748
Name:CHOATE, STEPHEN M (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:M
Last Name:CHOATE
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 1:901 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2322
Mailing Address - Country:US
Mailing Address - Phone:360-423-7847
Mailing Address - Fax:360-414-4112
Practice Address - Street 1:901 15TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2322
Practice Address - Country:US
Practice Address - Phone:360-423-7847
Practice Address - Fax:360-414-4112
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00022483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist