Provider Demographics
NPI:1114249596
Name:STEPHENS, SPENCER (PHARMD)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 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:205-425-4595
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:205-425-4595
Practice Address - Fax:205-425-0701
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist