Provider Demographics
NPI:1427189091
Name:STEVENSON, JAMES DONALD (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DONALD
Last Name:STEVENSON
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 1:3555 KENMORE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-3502
Mailing Address - Country:US
Mailing Address - Phone:248-544-0757
Mailing Address - Fax:
Practice Address - Street 1:2990 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1414
Practice Address - Country:US
Practice Address - Phone:248-541-0158
Practice Address - Fax:248-541-4624
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist