Provider Demographics
NPI:1245552157
Name:STUMPF, EDWARD CHARLES
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:CHARLES
Last Name:STUMPF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 TEDESCO CT
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-5116
Mailing Address - Country:US
Mailing Address - Phone:518-355-8979
Mailing Address - Fax:
Practice Address - Street 1:604 TEDESCO CT
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-5116
Practice Address - Country:US
Practice Address - Phone:518-355-8979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist