Provider Demographics
NPI:1871806901
Name:PRIMES, STEPHEN JAMES
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JAMES
Last Name:PRIMES
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 1:7 GAVIN CIR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-4262
Mailing Address - Country:US
Mailing Address - Phone:978-475-3299
Mailing Address - Fax:
Practice Address - Street 1:25 WOOD ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-1518
Practice Address - Country:US
Practice Address - Phone:978-458-6397
Practice Address - Fax:978-458-1048
Is Sole Proprietor?:No
Enumeration Date:2010-07-18
Last Update Date:2010-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17671183500000X
NHR1459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist