Provider Demographics
NPI:1801104104
Name:STAPF, KEVIN (DPH)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:STAPF
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8223 JACK RUSSELL CT
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-3077
Mailing Address - Country:US
Mailing Address - Phone:865-607-0059
Mailing Address - Fax:
Practice Address - Street 1:380 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6221
Practice Address - Country:US
Practice Address - Phone:865-483-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2013-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000011187183500000X
TN11167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist