Provider Demographics
NPI:1790414969
Name:KAZMER, STEPHEN V
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:V
Last Name:KAZMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MCKIVISON CT
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-1179
Mailing Address - Country:US
Mailing Address - Phone:616-443-7354
Mailing Address - Fax:
Practice Address - Street 1:1471 MARTIN ST
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-3066
Practice Address - Country:US
Practice Address - Phone:814-237-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP454809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist