Provider Demographics
NPI:1871516377
Name:STEPHENS, JOHN RAYMOND (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RAYMOND
Last Name:STEPHENS
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 1:2 ADOBE DR
Mailing Address - Street 2:
Mailing Address - City:WEST HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-9760
Mailing Address - Country:US
Mailing Address - Phone:585-359-2189
Mailing Address - Fax:
Practice Address - Street 1:2975 BRIGHTON HENRIETTA TOWN LINE RD
Practice Address - Street 2:BUILDING 2 SUITE 230
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2787
Practice Address - Country:US
Practice Address - Phone:585-461-1314
Practice Address - Fax:585-461-1318
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY033090OtherPHARMACIST LICENSE