Provider Demographics
NPI:1003976119
Name:STEPHENS PHARMACY INC
Entity Type:Organization
Organization Name:STEPHENS PHARMACY INC
Other - Org Name:STEPHENS PHARMACY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-408-4484
Mailing Address - Street 1:2600 15TH STREET RD
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-3606
Mailing Address - Country:US
Mailing Address - Phone:205-425-4592
Mailing Address - Fax:205-425-0701
Practice Address - Street 1:2600 15TH STREET RD
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-3606
Practice Address - Country:US
Practice Address - Phone:205-425-4592
Practice Address - Fax:205-425-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1069703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0104252OtherNCPDP PROVIDER IDENTIFICATION NUMBER