Provider Demographics
NPI:1699012641
Name:MAYHOOD, STEPHEN ROSS JR (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ROSS
Last Name:MAYHOOD
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4255 US 1 S STE 1
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-7000
Mailing Address - Country:US
Mailing Address - Phone:904-794-1104
Mailing Address - Fax:904-794-5590
Practice Address - Street 1:4255 US 1 S STE 1
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-7000
Practice Address - Country:US
Practice Address - Phone:904-794-1104
Practice Address - Fax:904-794-5590
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist