Stephanus Johannes Van Wyk
Individual provider Active NPI Pharmacist · Halifax, PA
NPI 1639323249 · NPPES record last updated Nov 10, 2008
Key facts
- NPI
- 1639323249
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RP441444 (PA)
- Practice address
- 3773 Peters Mountain Rd
Halifax, PA 17032-8605 - Phone
- (717) 896-9084
- NPI assigned
- Nov 10, 2008
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP441444 | PA | MD | Pharmacist |
| RPI001089 | PA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rite Aid of Pennsylvania LLC | Past | Accepting new patients | |
| Rite Aid of Pennsylvania LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPI001089 | PA | |
| Pharmacist | 183500000X | RP441444 | PA | Yes |
Addresses
Primary practice location
3773 Peters Mountain Rd
Halifax, PA 17032-8605
Mailing address
502 Thomas Rd
Camp Hill, PA 17011-1260
Phone (717) 763-1133
Other providers in Halifax, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 10, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.