Provider Demographics
NPI:1699085241
Name:CZERKES, STEPHEN MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:CZERKES
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 1:01294 FOREST LANE
Mailing Address - Street 2:
Mailing Address - City:BOYNE CITYT
Mailing Address - State:MI
Mailing Address - Zip Code:49712
Mailing Address - Country:US
Mailing Address - Phone:231-582-5265
Mailing Address - Fax:231-439-0851
Practice Address - Street 1:1401 SPRING ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770
Practice Address - Country:US
Practice Address - Phone:231-347-7281
Practice Address - Fax:231-439-0851
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist