Provider Demographics
NPI:1821497025
Name:FERNANDO, STEPHEN (PHARMD, PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:FERNANDO
Suffix:
Gender:M
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13520 TAMIAMI TRL N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-6341
Mailing Address - Country:US
Mailing Address - Phone:239-593-6724
Mailing Address - Fax:
Practice Address - Street 1:13520 TAMIAMI TRL N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-6341
Practice Address - Country:US
Practice Address - Phone:239-593-6724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist