Provider Demographics
NPI:1215470620
Name:STANTON, STEPHEN (RPH)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:STANTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3848 DAILY HILL RD
Mailing Address - Street 2:
Mailing Address - City:KENNEDY
Mailing Address - State:NY
Mailing Address - Zip Code:14747-9530
Mailing Address - Country:US
Mailing Address - Phone:716-267-3850
Mailing Address - Fax:
Practice Address - Street 1:26 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREWSBURG
Practice Address - State:NY
Practice Address - Zip Code:14738-9665
Practice Address - Country:US
Practice Address - Phone:716-569-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048411183500000X
PARP036154L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist