Provider Demographics
NPI:1053575290
Name:SQUIRES, STEPHEN B (BS PHARMACY)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:B
Last Name:SQUIRES
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RIVENDELL CT
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22603-8629
Mailing Address - Country:US
Mailing Address - Phone:540-545-8301
Mailing Address - Fax:540-545-8327
Practice Address - Street 1:200 RIVENDELL CT
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603-8629
Practice Address - Country:US
Practice Address - Phone:540-545-8301
Practice Address - Fax:540-545-8327
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist