Provider Demographics
NPI:1962524710
Name:WOLTANSKI, STEPHEN FRANCIS (RPH)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:FRANCIS
Last Name:WOLTANSKI
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 105
Mailing Address - Street 2:
Mailing Address - City:NEW ERA
Mailing Address - State:MI
Mailing Address - Zip Code:49446-0105
Mailing Address - Country:US
Mailing Address - Phone:231-894-6408
Mailing Address - Fax:
Practice Address - Street 1:3001 WEST M20
Practice Address - Street 2:
Practice Address - City:NEW ERA
Practice Address - State:MI
Practice Address - Zip Code:49446
Practice Address - Country:US
Practice Address - Phone:231-861-6942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020202521835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric