Provider Demographics
NPI:1346557345
Name:STEVENS, YVETTE (RPH)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:
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 1:86053 MEADOWFIELD BLUFFS RD
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-8414
Mailing Address - Country:US
Mailing Address - Phone:904-849-7114
Mailing Address - Fax:904-849-7286
Practice Address - Street 1:86053 MEADOWFIELD BLUFFS RD
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-8414
Practice Address - Country:US
Practice Address - Phone:904-849-7114
Practice Address - Fax:904-849-7286
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-12
Last Update Date:2010-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS00034445183500000X
GARPH025312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist