Provider Demographics
NPI:1871637090
Name:STEFANACCI, RICHARD B (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:B
Last Name:STEFANACCI
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 1:125 MILTON DR
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1671
Mailing Address - Country:US
Mailing Address - Phone:330-633-5846
Mailing Address - Fax:330-796-0236
Practice Address - Street 1:45 GOODYEAR BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-4032
Practice Address - Country:US
Practice Address - Phone:330-796-0230
Practice Address - Fax:330-796-0236
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-9914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist