Provider Demographics
NPI:1811296676
Name:NORTHRUP, STEPHEN PAUL (RPH)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:PAUL
Last Name:NORTHRUP
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 1:2005 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-3721
Mailing Address - Country:US
Mailing Address - Phone:828-464-9393
Mailing Address - Fax:
Practice Address - Street 1:2005 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3721
Practice Address - Country:US
Practice Address - Phone:828-464-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-19
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC06744OtherPHARMACIST LICENSE NUMBER