Provider Demographics
NPI:1558964015
Name:STEPHENS, TREY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TREY
Middle Name:
Last Name:STEPHENS
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:PO BOX 498
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:GA
Mailing Address - Zip Code:31305-0498
Mailing Address - Country:US
Mailing Address - Phone:912-437-3784
Mailing Address - Fax:912-437-6242
Practice Address - Street 1:1229 NORTH WAY
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:GA
Practice Address - Zip Code:31305-9143
Practice Address - Country:US
Practice Address - Phone:912-437-3784
Practice Address - Fax:912-437-6242
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist