Provider Demographics
NPI:1467540997
Name:STEPHENSON, CAROLYN M (RPH)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-3022
Mailing Address - Country:US
Mailing Address - Phone:706-423-9686
Mailing Address - Fax:706-335-0984
Practice Address - Street 1:1751 N ELM ST
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-2316
Practice Address - Country:US
Practice Address - Phone:706-335-3111
Practice Address - Fax:706-335-0984
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH012425OtherPHARMACY STATE LICENCE