Individual
MR. STEPHEN PETER STEPHEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
1125 N PINE ST, DERIDDER, LA 70634-2819
(337) 462-5796
Mailing address
322 CLEMSON CIR, TYLER, TX 75703-4706
(903) 509-8847
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
011937
LA
Other
Enumeration date
06/23/2005
Last updated
08/19/2014
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