Provider Demographics
NPI:1093419053
Name:DOTSON, STEPHANIE MAE (CPHT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MAE
Last Name:DOTSON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-6516
Mailing Address - Country:US
Mailing Address - Phone:757-539-6359
Mailing Address - Fax:757-539-0821
Practice Address - Street 1:1517 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-6516
Practice Address - Country:US
Practice Address - Phone:757-539-6359
Practice Address - Fax:757-539-0821
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230020530183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician