Provider Demographics
NPI:1841922580
Name:GONSIOR, STEPHEN (PHARM D)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:GONSIOR
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7027 PINEHURST LN NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9686
Mailing Address - Country:US
Mailing Address - Phone:989-708-2843
Mailing Address - Fax:
Practice Address - Street 1:2990 BAY RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3302
Practice Address - Country:US
Practice Address - Phone:989-497-9316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist