Provider Demographics
NPI:1548573900
Name:STEPHENS COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:STEPHENS COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:843-686-3040
Mailing Address - Street 1:430 WILLIAM HILTON PKWY
Mailing Address - Street 2:STE 302B
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2424
Mailing Address - Country:US
Mailing Address - Phone:843-686-3040
Mailing Address - Fax:843-686-3035
Practice Address - Street 1:430 WILLIAM HILTON PKWY
Practice Address - Street 2:STE 302B
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2424
Practice Address - Country:US
Practice Address - Phone:843-686-3040
Practice Address - Fax:843-686-3035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC107483336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy