Provider Demographics
NPI:1407480445
Name:STEVENS, TIMOTHY CRAIG (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:CRAIG
Last Name:STEVENS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 S PALESTINE ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-2511
Mailing Address - Country:US
Mailing Address - Phone:903-675-5040
Mailing Address - Fax:903-675-7442
Practice Address - Street 1:419 S PALESTINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-2511
Practice Address - Country:US
Practice Address - Phone:903-675-5040
Practice Address - Fax:903-675-7442
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist