Provider Demographics
NPI:1598064172
Name:STEVENSON, DESHAWN TRAMARAL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DESHAWN
Middle Name:TRAMARAL
Last Name:STEVENSON
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 1:1740 CENTURY CIR NE APT 1353
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3049
Mailing Address - Country:US
Mailing Address - Phone:404-901-9605
Mailing Address - Fax:
Practice Address - Street 1:1436 DOGWOOD DR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5091
Practice Address - Country:US
Practice Address - Phone:770-860-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist