Provider Demographics
NPI:1184992513
Name:FELTON, STEPHANIE ELIZABETH (RPH)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELIZABETH
Last Name:FELTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 RIGSBY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-1115
Mailing Address - Country:US
Mailing Address - Phone:210-337-4282
Mailing Address - Fax:210-337-1728
Practice Address - Street 1:3065 RIGSBY AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-1115
Practice Address - Country:US
Practice Address - Phone:210-337-4282
Practice Address - Fax:210-337-1728
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist