Provider Demographics
NPI:1689763625
Name:GIROUX, STEPHEN L (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:L
Last Name:GIROUX
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 1:9034 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GASPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14067-9408
Mailing Address - Country:US
Mailing Address - Phone:716-735-9128
Mailing Address - Fax:716-735-3351
Practice Address - Street 1:81 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MIDDLEPORT
Practice Address - State:NY
Practice Address - Zip Code:14105-0188
Practice Address - Country:US
Practice Address - Phone:716-735-3261
Practice Address - Fax:716-735-3351
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY34099OtherLICENCE NUMBER