Provider Demographics
NPI:1801861752
Name:HOLSTON, STEPHEN S (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:S
Last Name:HOLSTON
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 1:2510 MUIR WOODS DR W
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-3470
Mailing Address - Country:US
Mailing Address - Phone:251-660-6195
Mailing Address - Fax:
Practice Address - Street 1:2952 MARKET ST
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-5163
Practice Address - Country:US
Practice Address - Phone:228-762-5664
Practice Address - Fax:228-762-5625
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE7513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSBT374330OtherDEA