Provider Demographics
NPI:1942532346
Name:HURLEY, JOSEPH STEPHEN SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:STEPHEN
Last Name:HURLEY
Suffix:SR
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 1:2831 INDIGO BAY DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-3944
Mailing Address - Country:US
Mailing Address - Phone:407-344-2411
Mailing Address - Fax:
Practice Address - Street 1:2831 INDIGO BAY DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3944
Practice Address - Country:US
Practice Address - Phone:407-344-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 22434183500000X
PARP031198L183500000X
MAPH17783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPH17783OtherBOARD OF REGISTRATION OF PHARMACY
PARP031198LOtherBUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS
FLPS 22434OtherDIVISION OF MEDICAL QUALITY ASSURANCE