Provider Demographics
NPI:1982205639
Name:CROSS, STEPHEN ANDREW
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ANDREW
Last Name:CROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 E MARKET ST STE 115
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8881
Mailing Address - Country:US
Mailing Address - Phone:540-442-7380
Mailing Address - Fax:
Practice Address - Street 1:2035 E MARKET ST STE 115
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8881
Practice Address - Country:US
Practice Address - Phone:540-442-7380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist