Provider Demographics
NPI:1396342150
Name:SHREWSBERRY, STEPHEN CLAUDE
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CLAUDE
Last Name:SHREWSBERRY
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 1:240 SWEET GRASS CT
Mailing Address - Street 2:
Mailing Address - City:ROCK
Mailing Address - State:WV
Mailing Address - Zip Code:24747-9542
Mailing Address - Country:US
Mailing Address - Phone:304-809-5320
Mailing Address - Fax:
Practice Address - Street 1:240 SWEET GRASS CT
Practice Address - Street 2:
Practice Address - City:ROCK
Practice Address - State:WV
Practice Address - Zip Code:24747-9542
Practice Address - Country:US
Practice Address - Phone:304-809-5320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV031493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy