Provider Demographics
NPI:1508188988
Name:STEPHENS, JENNIFER WISE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WISE
Last Name:STEPHENS
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 1:13521 OLD HIGHWAY 280
Mailing Address - Street 2:SUITE 245
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-1405
Mailing Address - Country:US
Mailing Address - Phone:205-408-4484
Mailing Address - Fax:205-408-4454
Practice Address - Street 1:13521 OLD HIGHWAY 280
Practice Address - Street 2:SUITE 245
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-1405
Practice Address - Country:US
Practice Address - Phone:205-408-4484
Practice Address - Fax:205-408-4454
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist