Provider Demographics
NPI:1316221302
Name:STEVERSON, TERENCE G (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:G
Last Name:STEVERSON
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 1:18500 CHERRYLAWN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2079
Mailing Address - Country:US
Mailing Address - Phone:313-521-0354
Mailing Address - Fax:
Practice Address - Street 1:25016 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3319
Practice Address - Country:US
Practice Address - Phone:586-498-8426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist