Provider Demographics
NPI:1578857793
Name:STEPHENS, DEREK CASEY (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:CASEY
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 1:4711 BAYOU BLVD
Mailing Address - Street 2:TARGET PHARMACY STORE NUMBER T-0686
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2607
Mailing Address - Country:US
Mailing Address - Phone:850-494-9077
Mailing Address - Fax:850-494-9077
Practice Address - Street 1:4711 BAYOU BLVD
Practice Address - Street 2:TARGET PHARMACY STORE NUMBER T-0686
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2607
Practice Address - Country:US
Practice Address - Phone:850-494-9077
Practice Address - Fax:850-494-9077
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist