Provider Demographics
NPI:1114028024
Name:STEPHENS, STEPHANIE HOLLAND (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:HOLLAND
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1716 APLIN ROAD
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32433
Mailing Address - Country:US
Mailing Address - Phone:850-834-5249
Mailing Address - Fax:
Practice Address - Street 1:1030 US HIGHWAY 331 S STE G
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-3391
Practice Address - Country:US
Practice Address - Phone:850-892-9668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0034078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist