Provider Demographics
NPI:1154948438
Name:ANDERSON, STEPHEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:ANDERSON
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 1:4121 HALIFAX RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-4833
Mailing Address - Country:US
Mailing Address - Phone:434-575-0511
Mailing Address - Fax:434-575-1366
Practice Address - Street 1:4121 HALIFAX RD
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-4833
Practice Address - Country:US
Practice Address - Phone:434-575-0511
Practice Address - Fax:434-575-1366
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist