Provider Demographics
NPI:1306443445
Name:STILLION, BRENT RUSSEL (RPH)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:RUSSEL
Last Name:STILLION
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 1:404 AETNA ST
Mailing Address - Street 2:
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-1960
Mailing Address - Country:US
Mailing Address - Phone:740-633-0831
Mailing Address - Fax:
Practice Address - Street 1:404 AETNA ST
Practice Address - Street 2:
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1960
Practice Address - Country:US
Practice Address - Phone:740-633-0831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist