Provider Demographics
NPI:1952905259
Name:FELL, STEPHEN DOUGLAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:FELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 US HIGHWAY 31 S
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-3061
Mailing Address - Country:US
Mailing Address - Phone:317-881-1655
Mailing Address - Fax:
Practice Address - Street 1:655 US HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-3061
Practice Address - Country:US
Practice Address - Phone:317-881-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021433A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist