Provider Demographics
NPI:1447558820
Name:STEVENS, BRET (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-7439
Mailing Address - Country:US
Mailing Address - Phone:336-996-7239
Mailing Address - Fax:336-992-9743
Practice Address - Street 1:971 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7439
Practice Address - Country:US
Practice Address - Phone:336-996-7239
Practice Address - Fax:336-992-9743
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0346858Medicaid
NC0346858Medicaid