Provider Demographics
NPI:1861505455
Name:KALIVAS, STEPHEN SPENCER (RPH)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:SPENCER
Last Name:KALIVAS
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 KARELITZ RD
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-4003
Mailing Address - Country:US
Mailing Address - Phone:978-531-7110
Mailing Address - Fax:
Practice Address - Street 1:2 KARELITZ RD
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-4003
Practice Address - Country:US
Practice Address - Phone:978-531-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist