Provider Demographics
NPI:1902004856
Name:GULLEY, STEPHEN M (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:M
Last Name:GULLEY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 TIMBER PT N
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-6625
Mailing Address - Country:US
Mailing Address - Phone:928-771-9585
Mailing Address - Fax:
Practice Address - Street 1:1230 TIMBER PT N
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-6625
Practice Address - Country:US
Practice Address - Phone:928-771-9585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist