Provider Demographics
NPI:1649539230
Name:STOLL, JOHN PHILIP (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PHILIP
Last Name:STOLL
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:PO BOX 816
Mailing Address - Street 2:
Mailing Address - City:CLARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28433-0816
Mailing Address - Country:US
Mailing Address - Phone:910-647-0437
Mailing Address - Fax:910-647-0696
Practice Address - Street 1:80 E GREEN ST
Practice Address - Street 2:
Practice Address - City:CLARKTON
Practice Address - State:NC
Practice Address - Zip Code:28433-5003
Practice Address - Country:US
Practice Address - Phone:910-647-0437
Practice Address - Fax:910-647-0696
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1982797114Medicaid
NC56-2033182OtherFED TX ID
NC0095224Medicaid
NC0095224Medicaid