Provider Demographics
NPI:1851464663
Name:DRAGOTAKES, STEPHEN CHRISTOPHER (RPH , BCNP)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:CHRISTOPHER
Last Name:DRAGOTAKES
Suffix:
Gender:M
Credentials:RPH , BCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-2108
Mailing Address - Country:US
Mailing Address - Phone:508-359-7214
Mailing Address - Fax:
Practice Address - Street 1:18 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-2108
Practice Address - Country:US
Practice Address - Phone:508-359-7214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA175451835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear