Provider Demographics
NPI:1699075168
Name:SELBY, STEPHEN MARK (RPH)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MARK
Last Name:SELBY
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:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:IDAHO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80452-0070
Mailing Address - Country:US
Mailing Address - Phone:303-567-2496
Mailing Address - Fax:303-567-2807
Practice Address - Street 1:2425 MINER ST.
Practice Address - Street 2:
Practice Address - City:IDAHO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80452-0070
Practice Address - Country:US
Practice Address - Phone:303-567-2496
Practice Address - Fax:303-567-2807
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist