Provider Demographics
NPI:1982033858
Name:STONEWALL FAMILY PHARMACY
Entity Type:Organization
Organization Name:STONEWALL FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOMCHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:318-925-9400
Mailing Address - Street 1:160 STONECREEK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:STONEWALL
Mailing Address - State:LA
Mailing Address - Zip Code:71078
Mailing Address - Country:US
Mailing Address - Phone:318-925-9400
Mailing Address - Fax:
Practice Address - Street 1:160 STONECREEK DR
Practice Address - Street 2:SUITE C
Practice Address - City:STONEWALL
Practice Address - State:LA
Practice Address - Zip Code:71078
Practice Address - Country:US
Practice Address - Phone:318-925-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy