Provider Demographics
NPI:1003105354
Name:STEVENS, CARRIE REGINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:REGINA
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 HARMS WAY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-7928
Mailing Address - Country:US
Mailing Address - Phone:606-598-1311
Mailing Address - Fax:
Practice Address - Street 1:560 MANCHESTER SQUARE SHPG CTR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-8779
Practice Address - Country:US
Practice Address - Phone:606-598-0414
Practice Address - Fax:606-599-8042
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist