Individual
MR. CLYDE STEPHENS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1155 FORD RD, ST LOUIS PARK, MN 55426-1099
(612) 284-2197
(612) 808-6759
Mailing address
1155 FORD RD, ST LOUIS PARK, MN 55426-1099
(612) 284-2197
(612) 808-6759
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
114249
MN
Other
Enumeration date
02/09/2012
Last updated
02/09/2012
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