Provider Demographics
NPI:1912073669
Name:STEVENHAGEN, JOHN ERNEST (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ERNEST
Last Name:STEVENHAGEN
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 1:1625 W COMET RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:44219-9476
Mailing Address - Country:US
Mailing Address - Phone:330-882-3878
Mailing Address - Fax:
Practice Address - Street 1:941 W NIMISILA RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319
Practice Address - Country:US
Practice Address - Phone:330-882-6767
Practice Address - Fax:330-882-3422
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-08852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist