Provider Demographics
NPI:1578201422
Name:STEVENSON, PAYTON RENEA (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAYTON
Middle Name:RENEA
Last Name:STEVENSON
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 1:525 BRIAR RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ODENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35120-2304
Mailing Address - Country:US
Mailing Address - Phone:205-410-9302
Mailing Address - Fax:
Practice Address - Street 1:340 E MEIGHAN BLVD
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1049
Practice Address - Country:US
Practice Address - Phone:256-547-8928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist