Provider Demographics
NPI:1316522865
Name:KERSHAW, STEPHEN (RPH)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:KERSHAW
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 1:9 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1056
Mailing Address - Country:US
Mailing Address - Phone:774-266-0538
Mailing Address - Fax:
Practice Address - Street 1:72 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-1354
Practice Address - Country:US
Practice Address - Phone:508-543-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH17975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty