Provider Demographics
NPI:1972149763
Name:ERNEST, STEPHEN P (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:ERNEST
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:KROGER PHARMACY STORE 248
Mailing Address - Street 2:100 FOREST PARK PLAZA
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834
Mailing Address - Country:US
Mailing Address - Phone:812-442-6700
Mailing Address - Fax:812-442-6606
Practice Address - Street 1:KROGER PHARMACY STORE 248
Practice Address - Street 2:100 FOREST PARK PLAZA
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834
Practice Address - Country:US
Practice Address - Phone:812-442-6700
Practice Address - Fax:812-442-6606
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017876A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist