Provider Demographics
NPI:1114474475
Name:STEVENS, JENNIFER LINDSLEY (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LINDSLEY
Last Name:STEVENS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CARRIEDALE LN
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6041
Mailing Address - Country:US
Mailing Address - Phone:207-251-4196
Mailing Address - Fax:
Practice Address - Street 1:11 CARRIEDALE LN
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6041
Practice Address - Country:US
Practice Address - Phone:207-985-3587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-04
Last Update Date:2016-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4906183500000X
NHR1695183500000X
MI5302028334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist