Provider Demographics
NPI:1396017158
Name:STEVENSON, TAKYIAH MONIQUE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAKYIAH
Middle Name:MONIQUE
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 S SALISBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5812
Mailing Address - Country:US
Mailing Address - Phone:410-219-5261
Mailing Address - Fax:
Practice Address - Street 1:735 S SALISBURY BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5812
Practice Address - Country:US
Practice Address - Phone:410-219-5261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19811183500000X
DEA1-0004095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist