Provider Demographics
NPI:1437457819
Name:STEVENS, JENNIFER MORTON (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MORTON
Last Name:STEVENS
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 1:240 S STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1818
Mailing Address - Country:US
Mailing Address - Phone:336-725-8311
Mailing Address - Fax:336-723-7811
Practice Address - Street 1:240 S STRATFORD RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1818
Practice Address - Country:US
Practice Address - Phone:336-725-8311
Practice Address - Fax:336-723-7811
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0346733Medicaid