Provider Demographics
NPI:1457643967
Name:STEPHENS, RICHARD BROUGHTON (RPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:BROUGHTON
Last Name:STEPHENS
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 1:301 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4307
Mailing Address - Country:US
Mailing Address - Phone:252-726-0777
Mailing Address - Fax:
Practice Address - Street 1:301 PENNY LN
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4307
Practice Address - Country:US
Practice Address - Phone:252-726-0777
Practice Address - Fax:252-726-6497
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist