Provider Demographics
NPI:1811185408
Name:COMSTOCK, STEPHEN DWIGHT (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:DWIGHT
Last Name:COMSTOCK
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 1:10350 DASON DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-1935
Mailing Address - Country:US
Mailing Address - Phone:208-322-5245
Mailing Address - Fax:
Practice Address - Street 1:6725 GLENWOOD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-1926
Practice Address - Country:US
Practice Address - Phone:208-319-1271
Practice Address - Fax:208-319-1274
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP-4064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist