Provider Demographics
NPI:1699959858
Name:FORD, STEPHEN M (PHARMD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:FORD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TF62 MEDICAL BRIGADE
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09342
Mailing Address - Country:IQ
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5113 LEESBURG PIKE
Practice Address - Street 2:SUITE 402
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3204
Practice Address - Country:US
Practice Address - Phone:703-681-5101
Practice Address - Fax:703-681-4692
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035935L1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy