Provider Demographics
NPI:1891878393
Name:SWEENEY, STEPHEN JOHN (RPH, PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOHN
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 ALLEGRO LN
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2772
Mailing Address - Country:US
Mailing Address - Phone:813-645-7553
Mailing Address - Fax:
Practice Address - Street 1:179 E. BLOOMINGDALE AVENUE,
Practice Address - Street 2:WINN-DIXIE PHARMACY #0676
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8102
Practice Address - Country:US
Practice Address - Phone:813-681-9858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0024684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050097Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION