Provider Demographics
NPI:1972837227
Name:STEPHENS, WILLARD E (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLARD
Middle Name:E
Last Name:STEPHENS
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 1:2769 PAPERMILL RD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3329
Mailing Address - Country:US
Mailing Address - Phone:610-374-9942
Mailing Address - Fax:610-374-9942
Practice Address - Street 1:2769 PAPERMILL RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3329
Practice Address - Country:US
Practice Address - Phone:610-374-9942
Practice Address - Fax:610-374-9942
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040821L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist